Abstract
BACKGROUND: Both erythropoiesis stimulating agents and intravenous iron supplements are used in end-stage renal disease patients to treat anemia, as these patients require large amounts of iron. Due to abnormalities in transferrin binding capacity and an abrupt massive amount loading of iron, transferrin can rapidly become saturated by iron, and non-transferrin-bound iron (NTBI) may then be present in plasma. This excess iron generates free radicals leading to many complications. A marker is therefore required to monitor whether or not iron supplements should be administered to these patients.METHODS: One hundred and fifty-four hemodialysis patients were enrolled in this study, all of whom received hemodialysis therapy three times a week for at least two years. We recorded hematological and biochemical data and stopped using any forms of iron supplement for at least 7 days before the study. Fifty-one healthy individuals were enrolled as normal controls, and all patients fasted for at least 8 hours before blood sampling.RESULTS: The NTBI levels of 141 hemodialysis patients were below 5.6 μg/dL, and 13 (8.4%) had levels higher than 5.6 μg/dL. The serum iron level and transferrin saturation were significantly higher in the NTBI ≥ 5.6 μg/dL group (95.6 ± 39.6 μg/dL vs. 158.7 ± 47.4 μg/dL, P ＜ 0.001; 38.9 ± 16.1% vs. 78.1 ± 25.2%, P ＜ 0.001). The ferritin level was also higher in the NTBI ≥ 5.6 μg/dL group (461.6 ± 297.4 ng/mL vs. 662.8 ± 363.3 ng/mL, P = 0.023). The transferrin level was higher in the NTBI ＜ 5.6 μg/dL group (198.5 ± 49.8 mg/dL vs. 151.7 ± 35.0 mg/dL, P = 0.008). Even though the transferrin saturation was below 100%, NTBI ≥ 5.6 μg/dL was still found.CONCLUSION: Current iron markers do not accurately reflect the iron storage status of patients. The existence of NTBI in patients means that transferrin has not fully bound all of the iron, and therefore NTBl could be used as a marker to confirm iron overload in hemodialysis patients.
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