Baseline Serum Ferritin Levels Research Articles

Effects of Luspatercept on Iron Overload and Impact on Responders to Luspatercept: Results from the BELIEVE Trial

Effects of Luspatercept on Iron Overload and Impact on Responders to Luspatercept: Results from the BELIEVE Trial

Efficacy of deferasirox median dose of 30 mg/kg /day in pediatric patients with β- thalassemia major during one year follow- up therapy.

Objective: To assess the efficacy of deferasirox median dose of 30 mg /kg /day in pediatric patients with β- thalassemia major during one year of follow up Patients and methods: This study was conducted at Ibn Al Atheer center of thalassemia, Mosul city, Iraq during the period from 3rd of February 2013 to 2nd of February 2014. Serum ferritin was measured at baseline and at four weekly intervals thereafter among 49 transfusion dependent children with β-thalassemia major, who were treated with median deferasirox dose of 30 mg /kg /day. Results: No statistically significant difference was detected between mean serum ferritin level at baseline (2189.39 ± 85.7) ng/mL and its mean value at four weekly intervals during forty-eight weeks of deferasirox therapy. There was significant (p = 0.027) improvement of serum ferritin at fifty – two weeks reading (1750.6 ± 202.8 ng/mL) compared to baseline reading. Percentage of patients with baseline serum ferritin levels of >2,500 ng/ml was 32.7% (16/49), which increased significantly (p=0.000) to 65% at four weeks of therapy, and ranged between 32.1% - 46.2 % in the remaining readings. Conclusions: There was no significant reduction of serum ferritin during initial forty-eight weeks of deferasirox median dose of 30 mg /kg /day among patient with baseline mean serum ferritin above 2000 ng /ml.

Different Effects of Iron Indices on Mortality in Patients With Autosomal Dominant Polycystic Kidney Disease After Long-Term Hemodialysis: A Nationwide Population-Based Study

Iron supplementation and erythropoietin stimulating agents (ESAs) are essential for maintaining hemoglobin levels in hemodialysis patients. However, patients with autosomal-dominant polycystic kidney disease (PKD) have higher endogenous erythropoietin levels, so their recommended iron indices for hemodialysis patients may differ. This study evaluated iron profiles, including ferritin levels and transferrin saturation (TSAT) to identify factors affecting mortality in patients on dialysis, and those associated with mortality in patients with and without PKD. This cohort study from the Taiwan Renal Registry Data System stratified mortality risk by the presence of PKD recorded as the underlying disease. We enrolled 1346 hemodialysis patients with PKD and 82,873 hemodialysis patients without PKD. The primary outcome was 3-year all-cause mortality. Predictors included time-averaged and baseline serum ferritin levels and TSAT. Multivariate Cox regression analysis adjusting for age, comorbidities, and relevant laboratory parameters was used to estimate the all-cause hazard ratios (HRs) for mortality. The mean ages of patients with and without PKD were 56.2±13.2 and 61.7±13.5 years and the median follow-up time was 37 (15-76) months. The adjusted mortality risks for time-averaged ferritin levels >800 ng/mL (HR=1.52; 95% confidence interval: 1.40-1.65) or TSAT levels >50% (HR=1.46; 95% confidence interval: 1.30-1.65) were significantly higher among patients without PKD than those for patients with normal iron indices. However, a U-shaped curve of mortality against ferritin/TSAT levels was not observed in patients with PKD. In the sensitivity test, there was no difference among PKD patients who underwent regular ESA therapy and those who did not. Iron indices have different effects on mortality among patients with and without PKD. Iron supplementation, recommended serum ferritin levels, or TSAT should be monitored in hemodialysis patients, especially those without PKD. Clinicians should consider treating anemia in hemodialysis patients individually, especially in PKD.

Elevated serum ferritin concentration is associated with incident type 2 diabetes mellitus in a Chinese population: A prospective cohort study

AimsWe aimed to evaluate the association between serum ferritin levels and incident type 2 diabetes mellitus risk in a Chinese population. MethodsThis cohort study assessed 2225 Chinese individuals aged 25–75 years. Diabetes mellitus was diagnosed using the 1999 World Health Organization definition with a median follow-up period of 20 months. Cox proportional hazard models were used to estimate adjusted hazard ratios and 95% confidence intervals (CI) for incident diabetes when serum ferritin concentrations increased by one standard deviation. ResultsDuring the follow-up period, 112 cases (62 men and 50 women) of type 2 diabetes mellitus were identified. Baseline serum ferritin levels were higher in the diabetes than the non-diabetes group. After adjusting for age, body mass index, waist circumference, mean arterial pressure, fasting plasma glucose, fasting insulin, hemoglobin A1c, total cholesterol, high-density lipoprotein cholesterol, alanine transaminase and triglyceride levels, family history of diabetes mellitus, pork meat consumption, neutrophil/lymphocyte ratio, education, and annual household income, the hazard ratios for incident diabetes corresponding to one standard deviation increase in serum ferritin levels were 1.17 (95% CI 1.03, 1.34), 1.20 (95% CI 1.003, 1.43), and 1.03 (95% CI 0.82, 1.31) for the total population, men, and women, respectively. ConclusionsHigh serum ferritin levels were associated with a higher risk of incident type 2 diabetes mellitus independent of traditional risk factors in the total population and men.

Serum Ferritin Levels in Blacks Without Known Cardiovascular Disease (from the Jackson Heart Study)

There has been conflicting results regarding the role of ferritin, a nonspecific marker of systemic inflammation, in the development of coronary heart disease (CHD). We aimed to evaluate the association of serum ferritin with incident CHD, incident stroke, and subclinical measurements of atherosclerosis among blacks. For our prospective study, we utilized data from the Jackson Heart Study. Eligible participants (n = 4,659) who were free from CHD were enrolled in 2000 to 2004. The participants' baseline serum ferritin levels were obtained, and they were followed up for an average of 8 years to identify incident CHD events and incident stroke. We used multivariate linear regression and Cox proportional hazard models to evaluate the association of serum ferritin with incident CHD events and incident stroke. The age-adjusted correlations between ferritin and specific study covariates, including carotid intima-media thickness, coronary artery calcium, and abdominal aortic calcium, were obtained. During an average of 8 years of follow-up, 161 incident CHD events and 117 incident stroke events were documented. There was no significant association between ferritin levels and incident CHD events (p = 0.54 in men and p = 0.31 in women) and incident stroke (p = 0.17 in men and p = 0.56 in women), or both considered together (p = 0.70 in men and p = 0.69 in women). Ferritin was significantly correlated with abdominal aortic calcium (r = 0.09, p <0.01) in women but not in men. In conclusion, a higher serum ferritin level was not associated with an increased risk of incident CHD events or incident stroke, and may not be an independent predictor of incident CHD or stroke in blacks.

The association between serum ferritin levels and the risk of new-onset type 2 diabetes mellitus: A 10-year follow-up of the Chinese Multi-Provincial Cohort Study.

To investigate the association of serum ferritin levels and ferritin level changes with the 10-year risk of new-onset type 2 diabetes mellitus (T2DM). Among 2359 subjects without T2DM at baseline in 2002, 1956 subjects were re-examined in 2007, and 1660 subjects were invited to be re-examined in 2012. Serum ferritin (ng/ml) levels were measured by latex-enhanced turbidimetric immunoassay. Five-year serum ferritin changes were categorized into four groups using the median as the cut-off point. Multivariate logistic regression was performed to examine the independent association of serum ferritin levels and 5-year ferritin level changes with 10-year new-onset T2DM. At the 10-year follow-up, 205 (12.3%) subjects had developed new-onset T2DM. After adjusting for traditional risk factors and high-sensitivity C-reactive protein, 10-year new-onset T2DM risk was significantly increased in subjects in the highest tertile of baseline serum ferritin levels [odds ratio (OR)=1.80, 95% confidence interval (CI): 1.17-2.79] and in subjects with high serum ferritin levels in both 2002 and 2007 (OR=1.54, 95% CI: 1.01-2.34). After adjusting for baseline fasting blood glucose, the effect was attenuated and became borderline or non-significant. Serum ferritin levels and ferritin level changes were associated with 10-year new-onset T2DM risk in the Chinese population, whereas the independent effect awaits validation from studies with larger sample sizes.

BETA THALASSEMIA MAJOR;

Introduction: β-Thalassemia major (β-TM) is a genetic haemoglobin disorderwhich is relatively common in some geographical areas. β-TM is characterized by severe anaemia,which needs a continuous blood transfusion regimen starting from the first months of life toprolong survival. Objectives: To compare mean reduction in serum ferritin level with deferasiroxand desferrioxamine when used as an iron chelator in multi-transfused beta thalassemia major.Study design: Randomized controlled trial. Setting: Thalassemia clinic, The Children’s Hospitaland The Institute of Child Health, Lahore. Duration of Study with Dates: Study was carried outover a period of nine months from 28-06-2015 to 27-03-2016. Subjects and Methods: A totalof 100 patients (50 patients in each group). The patients were randomly allocated into twogroups using random numbers stable. Group-A received Deferasirox and group-B receivedDesferrioxamine. Results: Mean age of the patients was 7.42±4.13 and 7.87±4.13 in group-Aand B, respectively. Regarding sex distribution, 26 patients (52.0%) in group-A and 28 patients(56.0%) in group-B were male while 24 patients (48.0%) in group-A and 22 patients (44.0%) ingroup-B were female. Reduction from baseline in group-A was 783.60±413.66 ng/ml and ingroup-B 552.80±155.45 ng/ml (P&lt;0.001) There was more reduction in group-A. In group-Abaseline serum ferritin level was 2495.00±1259.10 ng/ml and at 9 month 1712.00±1019.36 ng/ml (P&lt;0.001). Similarly in group-B baseline serum ferritin level was 2422.80±910.43 ng/ml andat 9 month 1883±862.72 ng/ml (P&lt;0.001). Conclusion: In conclusion, deferasirox was moreeffective in terms of reduction in serum ferritin level when compared with desferrioxamine inmulti-transfused beta thalassemia major patients.

English

Introduction: β-Thalassemia major (β-TM) is a genetic haemoglobin disorderwhich is relatively common in some geographical areas. β-TM is characterized by severe anaemia,which needs a continuous blood transfusion regimen starting from the first months of life toprolong survival. Objectives: To compare mean reduction in serum ferritin level with deferasiroxand desferrioxamine when used as an iron chelator in multi-transfused beta thalassemia major.Study design: Randomized controlled trial. Setting: Thalassemia clinic, The Children’s Hospitaland The Institute of Child Health, Lahore. Duration of Study with Dates: Study was carried outover a period of nine months from 28-06-2015 to 27-03-2016. Subjects and Methods: A totalof 100 patients (50 patients in each group). The patients were randomly allocated into twogroups using random numbers stable. Group-A received Deferasirox and group-B receivedDesferrioxamine. Results: Mean age of the patients was 7.42±4.13 and 7.87±4.13 in group-Aand B, respectively. Regarding sex distribution, 26 patients (52.0%) in group-A and 28 patients(56.0%) in group-B were male while 24 patients (48.0%) in group-A and 22 patients (44.0%) ingroup-B were female. Reduction from baseline in group-A was 783.60±413.66 ng/ml and ingroup-B 552.80±155.45 ng/ml (P&lt;0.001) There was more reduction in group-A. In group-Abaseline serum ferritin level was 2495.00±1259.10 ng/ml and at 9 month 1712.00±1019.36 ng/ml (P&lt;0.001). Similarly in group-B baseline serum ferritin level was 2422.80±910.43 ng/ml andat 9 month 1883±862.72 ng/ml (P&lt;0.001). Conclusion: In conclusion, deferasirox was moreeffective in terms of reduction in serum ferritin level when compared with desferrioxamine inmulti-transfused beta thalassemia major patients.

Increased serum ferritin levels are independently related to incidence of prediabetes in adult populations

AimTo comprehensively and exhaustively assess the relationship between serum ferritin levels and incidence of prediabetes in a prospective study. MethodsThis prospective cohort study (n=7380) with a mean follow-up of 3.07 years (range: 1–7, 95% CI: 3.03–3.12) was conducted in Tianjin, China. Blood fasting glucose, oral glucose tolerance test, serum ferritin levels and other potentially confounding factors were measured at baseline and at each year of follow-up. Adjusted Cox proportional hazards regression models were used to assess the gender-specific relationship between baseline and mean serum ferritin quintiles and prediabetes. ResultsThe incidence of prediabetes was 85 per 1000 person-years among men and 44 per 1000 person-years among women during follow-up (from 2007 to 2014). After adjusting for potential confounders, hazard ratios (95% CI) for prediabetes across baseline ferritin quintiles were: for men, 1.00, 1.13 (0.90–1.40), 1.20 (0.97–1.48), 1.41 (1.14–1.73) and 1.73 (1.41–2.11); and for women, 1.00, 1.01 (0.74–1.38), 0.68 (0.48–0.96), 0.84 (0.61–1.15) and 1.07 (0.80–1.45), respectively. Similar results were also observed for mean ferritin levels. ConclusionBoth baseline and mean serum ferritin levels were significantly and linearly related to prediabetes in men, whereas U-shaped relationships were observed between baseline and mean serum ferritin and prediabetes in women. The relationship between prediabetes risk and mean serum ferritin levels may be more stable than one with baseline serum ferritin levels.

The Different Association between Serum Ferritin and Mortality in Hemodialysis and Peritoneal Dialysis Patients Using Japanese Nationwide Dialysis Registry.

Background/AimsMonitoring of serum ferritin levels is widely recommended in the management of anemia among patients on dialysis. However, associations between serum ferritin and mortality are unclear and there have been no investigations among patients undergoing peritoneal dialysis (PD).MethodsBaseline data of 191,902 patients on dialysis (age, 65 ± 13 years; male, 61.1%; median dialysis duration, 62 months) were extracted from a nationwide dialysis registry in Japan at the end of 2007. Outcomes, such as one-year mortality, were then evaluated using the registry at the end of 2008.ResultsWithin one year, a total of 15,284 (8.0%) patients had died, including 6,210 (3.2%) cardiovascular and 2,707 (1.4%) infection-related causes. Higher baseline serum ferritin levels were associated with higher mortality rates among patients undergoing hemodialysis (HD). In contrast, there were no clear associations between serum ferritin levels and mortality among PD patients. Multivariate Cox regression analysis of HD patients showed that those in the highest serum ferritin decile group had higher rates of all-cause and cardiovascular mortality than those in the lowest decile group (hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.31–1.81 and HR, 1.44; 95% CI, 1.13–1.84, respectively), whereas associations with infection-related mortality became non-significant (HR, 1.14; 95% CI, 0.79–1.65).ConclusionsUsing Japanese nationwide dialysis registry, higher serum ferritin values were associated with mortality not in PD patients but in HD patients.

Serum ferritin is associated with carotid atherosclerotic plaques but not intima-media Thickness in patients with abnormal glucose metabolism

BackgroundWe investigated the association between serum ferritin and carotid artery lesions in populations with abnormal glucose metabolism. MethodsWe included 70 participants with abnormal glucose metabolism and 170 participants with normal glucose metabolism and measured their baseline serum ferritin levels. During follow-up carotid intima-media thickness and carotid plaque were evaluated. ResultsSerum ferritin levels were higher in the participants with abnormal glucose metabolism (p<0.01). We further divided the patients with abnormal glucose metabolism into subgroups with and without intima-media proliferation, and found that ferritin was excluded from the final equation in the logistic regression. Furthermore, age, waist circumference, ferritin, 2h-PG, and total cholesterol were significantly different between the subgroups with and without carotid plaque. When the above data were included in a logistic regression model, the p values obtained for age, ferritin, and 2h-PG were 0.004, 0.032, and 0.011, respectively. ConclusionsIn the Chinese population, serum ferritin levels are significantly increased in patients with abnormal glucose metabolism. The carotid intima-media thickness showed no independent relationship with serum ferritin in patients with abnormal glucose metabolism. However, high serum ferritin is an important risk factor for carotid atherosclerosis in these patients.

Association of Serum Ferritin Level with Risk of Incident Abnormal Glucose Metabolism in Southwestern China: a Prospective Cohort Study.

This prospective cohort study aimed to analyze the association between serum ferritin levels and the risk of abnormal glucose metabolism (AGM) in Southwestern Chinese population. The 383 subjects who are aged ≥20years and free of AGM at baseline between in 2007 and in 2008 were included in Southwestern China, and their baseline serum ferritin levels were measured. Among these subjects, 140 subjects were developed into AGM during the follow-up (2008-2012). In logistic regression models, the relative risk in the top versus that in the lowest quartile of serum ferritin levels was 2.86 (p=0.013) in females and 3.50 (p=0.029) in males after adjusting the age, gender, family history of diabetes, current smoking, and alcohol; however, serum ferritin levels were not significantly associated with incident of AGM after controlling for metabolic factors (waist circumference, systolic pressure (SBP), triglyceride (TG), and homeostasis model assessment formula insulin resistance (HOMA-IR)). Elevated serum ferritin levels are associated with AGM but not an independent risk factor.

Iron supplementation and mortality in incident dialysis patients: an observational study.

BackgroundStudies on the association between iron supplementation and mortality in dialysis patients are rare and conflicting.MethodsIn our observational single-center cohort study (INVOR study) we prospectively studied 235 incident dialysis patients. Time-dependent Cox proportional hazards models using all measured laboratory values for up to 7.6 years were applied to study the association between iron supplementation and all-cause mortality, cardiovascular and sepsis-related mortality. Furthermore, the time-dependent association of ferritin levels with mortality in patients with normal C-reactive protein (CRP) levels (<0.5 mg/dL) and elevated CRP levels (≧0.5 mg/dL) was evaluated by using non-linear P-splines to allow flexible modeling of the association.ResultsOne hundred and ninety-one (81.3%) patients received intravenous iron, 13 (5.5%) patients oral iron, whereas 31 (13.2%) patients were never supplemented with iron throughout the observation period. Eighty-two (35%) patients died during a median follow-up of 34 months, 38 patients due to cardiovascular events and 21 patients from sepsis. Baseline CRP levels were not different between patients with and without iron supplementation. However, baseline serum ferritin levels were lower in patients receiving iron during follow up (median 93 vs 251 ng/mL, p<0.001). Iron supplementation was associated with a significantly reduced all-cause mortality [HR (95%CI): 0.22 (0.08–0.58); p = 0.002] and a reduced cardiovascular and sepsis-related mortality [HR (95%CI): 0.31 (0.09–1.04); p = 0.06]. Increasing ferritin concentrations in patients with normal CRP were associated with a decreasing mortality, whereas in patients with elevated CRP values ferritin levels>800 ng/mL were linked with increased mortality.ConclusionsIron supplementation is associated with reduced all-cause mortality in incident dialysis patients. While serum ferritin levels up to 800 ng/mL appear to be safe, higher ferritin levels are associated with increased mortality in the setting of concomitant inflammation.

The incidental relationship between serum ferritin levels and hypertension

Background and objectiveAlthough several studies have shown an association between ferritin level and hypertension, only a few studies have investigated the longitudinal relationship between them. Thus, we evaluated the incidental risk for hypertension according to baseline ferritin level. Patients and methodsA total of 7104 healthy Korean men matched by a propensity score, who had participated in a medical health check-up program in 2005, were followed up from 2005 to 2010. They were divided into four groups according to baseline serum ferritin level (first quartile–fourth quartile). The incidence of hypertension was compared among the four groups, and the Cox-proportional hazard model was used to assess whether the development of hypertension was associated with higher baseline serum ferritin level. ResultsA total of 1252 (17.6%) cases had newly developed hypertension during the 26,339.5person-years of follow-up between 2006 and 2010. The adjusted hazard ratios (HRs) (95% confidence intervals, CIs) for incident hypertension were 1.00 (reference), 1.09 (0.91–1.30), 1.21 (1.01–1.45) and 1.28 (1.07–1.52), respectively (P for trend=0.003) through the quartiles of serum ferritin levels, respectively, after adjusting for multiple confounders. For the log-transformed serum ferritin levels as a continuous variable, adjusted HRs and 95% CIs for HTN were 1.15 (1.02–1.29). ConclusionsElevated serum ferritin level was independently associated with the incidental risk for hypertension in Korean men. This finding suggests the value of elevated ferritin level as an early predictor of hypertension.

Clinical significance of serum ferritin level as an independent predictor of insulin resistance in Korean men

AimsElevated serum ferritin level has been reported to be associated with type 2 diabetes mellitus and metabolic syndrome, which have significant relation with insulin resistance (IR). However, clinical association between serum ferritin level and IR remained unclear. Accordingly, this study was designed to evaluate the longitudinal effects of baseline serum ferritin level on the development of IR. MethodsAn IR-free 22,057 healthy Korean men (HOMA-IR<2.7), who had participated in a medical health check-up program in 2005, were followed up until 2010. During follow up, the development rate of IR, defined in case of HOMA-IR≥2.7, was monitored according to the quartile groups of serum ferritin levels. Cox proportional hazards models were used to measure the hazard ratios (HRs) of baseline serum ferritin levels on IR. ResultsDuring 77,471.1 person-years of follow-up, 4494 incident cases of insulin resistance developed between 2006 and 2010 (overall development rate: 20.4%). The development rate of IR increased in proportion to the baseline serum ferritin levels (quartile 1: 16.7%, quartile 2: 18.5%, quartile 3: 19.9%, quartile 4: 25.5%, P<0.001). After adjusting for multiple covariates, the HRs (95% CI) for IR, comparing the second to the fourth quartile of serum ferritin levels with the first quartile, were 1.11 (0.99–1.24), 1.19 (1.07–1.33) and 1.51 (1.35–1.68), respectively (P for trend <0.001). ConclusionsElevated serum ferritin level was independently associated with the future development of IR in Korean men.

Iron Status and the Acute Post-Exercise Hepcidin Response in Athletes

This study explored the relationship between serum ferritin and hepcidin in athletes. Baseline serum ferritin levels of 54 athletes from the control trial of five investigations conducted in our laboratory were considered; athletes were grouped according to values <30 μg/L (SF<30), 30–50 μg/L (SF30–50), 50–100 μg/L (SF50–100), or >100 μg/L (SF>100). Data pooling resulted in each athlete completing one of five running sessions: (1) 8×3 min at 85% vVO2peak; (2) 5×4 min at 90% vVO2peak; (3) 90 min continuous at 75% vVO2peak; (4) 40 min continuous at 75% vVO2peak; (5) 40 min continuous at 65% vVO2peak. Athletes from each running session were represented amongst all four groups; hence, the mean exercise duration and intensity were not different (p>0.05). Venous blood samples were collected pre-, post- and 3 h post-exercise, and were analysed for serum ferritin, iron, interleukin-6 (IL-6) and hepcidin-25. Baseline and post-exercise serum ferritin levels were different between groups (p<0.05). There were no group differences for pre- or post-exercise serum iron or IL-6 (p>0.05). Post-exercise IL-6 was significantly elevated compared to baseline within each group (p<0.05). Pre- and 3 h post-exercise hepcidin-25 was sequentially greater as the groups baseline serum ferritin levels increased (p<0.05). However, post-exercise hepcidin levels were only significantly elevated in three groups (SF30–50, SF50–100, and SF>100; p<0.05). An athlete's iron stores may dictate the baseline hepcidin levels and the magnitude of post-exercise hepcidin response. Low iron stores suppressed post-exercise hepcidin, seemingly overriding any inflammatory-driven increases.

High Serum Ferritin Levels Increase the Risk of Hyperuricemia: A Cross-Sectional and Longitudinal Study

Background/Aims: To examine the cross-sectional and longitudinal associations of serum ferritin levels with hyperuricemia. Methods: A cross-sectional and subsequently prospective study was performed among the employees of Zhenhai Refining and Chemical Company, Ningbo, China. In a cross-sectional study, the association between serum ferritin levels and the prevalence of hyperuricemia was analyzed. Subjects who were free of hyperuricemia at baseline were followed up annually to explore the prospective association between serum ferritin levels and hyperuricemia incidence. Results: Of the 10,074 subjects enrolled at baseline, 1,731 (17.18%) fulfilled the diagnostic criteria of hyperuricemia. Subjects with hyperuricemia presented significantly higher serum ferritin levels, and the levels were positively correlated with the prevalence of hyperuricemia. During a total of 22,367 person-years of follow-up, 502 subjects developed hyperuricemia. The overall incidence of hyperuricemia for 1,000 person-years of follow-up was 22.4, ranging from 17.6 in subjects with baseline serum ferritin levels in the first quintile to 19.2, 21.7, 23.9, and 30.7 in subjects in quintiles 2, 3, 4, and 5, respectively (p for trend < 0.001). Cox regression analyses showed that serum ferritin levels were positively associated with the risk of incident hyperuricemia. Conclusions: Our cross-sectional and longitudinal results indicate that high serum ferritin levels increase the risk of hyperuricemia.

Long-term hematological response in a patient with 5q- syndrome after suspension of lenalidomide therapy and further improvement with deferasirox therapy.

Long-term hematological response in a patient with 5q- syndrome after suspension of lenalidomide therapy and further improvement with deferasirox therapy.

Ferritin as a predictor of decline in residual renal function in peritoneal dialysis patients.

Background/AimsAims: Inflammation is an important factor in renal injury. Ferritin, an inflammatory marker, is considered an independent predictor of rapid renal progression in patients with chronic kidney disease. However, the relationship between ferritin and residual renal function (RRF) in patients undergoing peritoneal dialysis (PD) remains unclear.MethodsWe reviewed the medical records of patients who started PD between June 2001 and March 2012 at Soonchunhyang University Bucheon Hospital, Korea. A total of 123 patients were enrolled in the study. At 1 month after the initiation of PD, RRF was determined by a 24-hour urine collection and measured every 6 months thereafter. Clinical and biochemical data at the time of the initial 24-hour urine collection were considered as baseline.ResultsThe RRF reduction rate was significantly greater in patients with high ferritin (ferritin ≥ 250 ng/mL) compared with those with low ferritin (ferritin < 250 ng/mL; -1.71 ± 1.36 mL/min/yr/1.73 m2 vs. -0.84 ± 1.63 mL/min/yr/1.73 m2, respectively; p = 0.007). Pearson correlation analysis revealed a significant negative correlation between the baseline serum ferritin level and the RRF reduction rate (r = -0.219, p = 0.015). Using multiple linear regression analysis and adjusting for other risk factors, baseline serum ferritin was an independent factor for the RRF reduction rate (β = -0.002, p = 0.002).ConclusionsIn this study we showed that a higher ferritin level was significantly associated with a more rapid RRF decline in patients undergoing PD.

Serum Ferritin Is an Independent Prognostic Factor in Chinese with Myelodysplastic Syndromes Classified as IPSS Intermediate-1

Background: The International Prognostic Staging System (IPSS) for myelodysplastic syndromes (MDS) was developed predominately in patients of European ancestry and is not validated in Asians. In a recently revised IPSS (IPSS-R), several new prognostic variables are included, i.e. age, Eastern Cooperative Oncology Group performance score (ECOG PS), serum ferritin and lactate dehydrogenase. Chinese with MDS offer a unique opportunity to distinguish the prognostic impacts of haemoglobin (HGB) concentration, red blood cell (RBC) transfusions and serum ferritin because in China, patients rarely receive RBC transfusions unless the HGB concentration is <6.0 g/dl. Methods: We studied prognostic variables in 191 untreated Chinese primary patients with MDS intermediate-1 (INT-1) in the IPSS. Results: Serum ferritin level ≥500 µg/l at diagnosis was a strong independent predictor of survival. Although baseline serum ferritin level was inversely correlated with baseline HGB, it was the serum ferritin, not the baseline HGB level, that was significantly correlated with survival in Chinese patients. A new prognostic scoring system including the ECOG PS, absolute neutrophil level, serum ferritin, percentage of bone marrow blasts and poor karyotype was developed for Chinese with IPSS INT-1 MDS. Conclusions: This revised scoring system identified a subgroup of Chinese with MDS and INT-1 IPPS who have a poor prognosis and may benefit from more intensive therapy.