Soluble transferrin receptor concentration compared with reticulocyte hemoglobin content as a reliable marker of iron deficiency anemia in hemodialysis patients

Abstract

Abstract Introduction Adequate iron stores are necessary for successful erythropoiesis-stimulating agents (ESAs) therapy in hemodialysis (HD) patients. However, iron status estimation in HD patients remains challenging, as most parameters are affected by inflammation. We aimed to compare the performance of soluble transferrin receptor concentration (sTfR) and reticulocyte hemoglobin content (CHr) as potential markers for iron status assessment. Methods This was a cross-sectional study that included 60 anemic patients with kidney failure on regular HD for a minimum of 3 months. Patients were in the maintenance phase of the ESAs with stable doses for at least 4 weeks and at least 3 weeks free of iron therapy. Patients were classified into two groups; group I: 18 patients with noniron deficiency anemia (NIDA); transferrin saturation (TSAT) greater than 20% and ferritin greater than 200 ng/ml and group II: 42 patients with iron deficiency anemia (IDA); transferrin saturation less than 20% and/or ferritin less than 200 ng/ml. CHr and sTfR were evaluated as reliable markers for diagnosing iron deficiency. Results CHr was significantly lower while sTfR was significantly higher in patients with IDA. Based on the receiver operating characteristic (ROC) curve, the area under the curve (AUC) of sTfR was significantly larger than the area under the curve of CHr; however, this had a borderline significance. Conclusion sTfR has a significantly higher diagnostic power for diagnosis of IDA than CHr.