Assessing the Association between Serum Ferritin, Transferrin Saturation, and C-Reactive Protein in Northern Territory Indigenous Australian Patients with High Serum Ferritin on Maintenance Haemodialysis.

Sandawana William Majoni,Alan Cass,Federica Barzi,Jaquelyne T Hughes,Paul D Lawton

doi:10.1155/2017/5490963

Sandawana William Majoni, Alan Cass + Show 3 more

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https://doi.org/10.1155/2017/5490963

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Abstract

Objective. To determine the significance of high serum ferritin observed in Indigenous Australian patients on maintenance haemodialysis in the Northern Territory, we assessed the relationship between ferritin and transferrin saturation (TSAT) as measures of iron status and ferritin and C-reactive protein (CRP) as markers of inflammation. Methods. We performed a retrospective cohort analysis of data from adult patients (≥18 years) on maintenance haemodialysis (>3 months) from 2004 to 2011. Results. There were 1568 patients. The mean age was 53.9 (11.9) years. 1244 (79.3%) were Indigenous. 44.2% (n = 693) were male. Indigenous patients were younger (mean age [52.3 (11.1) versus 57.4 (15.2), p < 0.001]) and had higher CRP [14.7 mg/l (7–35) versus 5.9 mg/l (1.9–17.5), p < 0.001], higher median serum ferritin [1069 µg/l (668–1522) versus 794.9 µg/l (558.5–1252.0), p < 0.001], but similar transferrin saturation [26% (19–37) versus 28% (20–38), p = 0.516]. We observed a small positive correlation between ferritin and TSAT (r2 = 0.11, p < 0.001), no correlation between ferritin and CRP (r2 = 0.001, p < 0.001), and positive association between high serum ferritin and TSAT (p < 0.001), Indigenous ethnicity (p < 0.001), urea reduction ratio (p = 0.001), and gender (p < 0.001) after adjustment in mixed regression analysis. Conclusion. Serum ferritin and TSAT may inadequately reflect iron status in this population. The high ferritin was poorly explained by inflammation.

Highlights

The effective treatment of anaemia in patients on maintenance haemodialysis (MHD) includes identification and correction of iron deficiency [1], use of erythropoiesis stimulating agents (ESA) as necessary, and achieving dialysis adequacy
Given the concerns of high dose iron supplementation in ESKD among populations with high background serum ferritin levels and high comorbid cardiovascular disease, in this study, we examined the relationship between serum ferritin levels and transferrin saturation (TSAT) as measures of iron status and serum ferritin levels and C-reactive protein (CRP) as markers of inflammation among Indigenous Australian patients dependent on MHD [7]
We report a population of MHD clients with high ESA usage, hyperferritinaemia, and low-normal TSAT

Summary

Introduction

The effective treatment of anaemia in patients on maintenance haemodialysis (MHD) includes identification and correction of iron deficiency [1], use of erythropoiesis stimulating agents (ESA) as necessary, and achieving dialysis adequacy. Interpretation of iron status from most guidelines on anaemia management in people on MHD has been mainly based on transferrin saturation [the ratio of serum iron to the total iron binding capacity (TIBC) as a percentage, TSAT] and serum ferritin. The accurate determination of iron status is critical in patients dependent on maintenance haemodialysis in order to avoid overtreatment resulting in iron overload and minimising continuing anaemia from undertreatment of iron deficiency. The combination of serum ferritin levels and TSAT are commonly used worldwide in Renal Anaemia Management guidelines [2, 5].

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