Document Detail

Association between transferrin receptor-ferritin index and conventional measures of iron responsiveness in hemodialysis patients.
MedLine Citation:
PMID:  16731299     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The diagnostic power of the transferrin receptor-ferritin (TfR-F) index for identification of iron responsiveness in long-term hemodialysis (HD) patients compared with the routine markers recommended by the current US and European guidelines was appraised. METHODS: Initially, 121 long-term HD patients with a serum ferritin level less than 800 microg/L and on recombinant erythropoietin (rHuEPO) therapy for longer than 6 months were enrolled for intravenous iron (IVFE) supplementation (100 mg of iron polymaltose 3 times/wk for 4 weeks, then 100 mg every 2 weeks for 5 months). Routine iron tests (ie, serum ferritin and transferrin saturation [TSAT]), TfR-F index calculated by the ratio of soluble TfR to log ferritin level, hematocrit, hemoglobin, red blood cell count, and serum high-sensitive C-reactive protein were examined at baseline. Hematocrit and hemoglobin were followed up every 2 weeks during the study period. RESULTS: One hundred patients (52 men, 48 women; mean age, 59 years) completed this study. Fifty-two patients were IVFE responders, defined as an increase in hematocrit greater than 3% and/or a decrease in rHuEPO dose greater than 30% of baseline values at the end of the study, and 48 nonresponders did not fulfill these criteria. Of 52 responders, only 14 patients (27%) could be recognized for iron deficiency by means of routine iron tests (ferritin < 100 microg/L and/or TSAT < 20%). Thirty-three responders (63%) could be further identified for iron deficiency by using TfR-F index (> 0.6), but 5 (10%) still could not by either method. Analyses by using receiver operating characteristic (ROC) curves showed that a cutoff value greater than 0.6 for TfR-F index had greater sensitivity (90%) for the detection of iron deficiency than ferritin level less than 100 microg/L (29%) and TSAT less than 20% (6%). TfR-F index showed a greater area under the ROC curve than ferritin level (P < 0.05) and TSAT (P < 0.001). CONCLUSION: TfR-F index is superior to routine tests for predicting response to IVFE supplementation in long-term HD patients. Our study indicates that TfR-F index is a new and surrogate marker to estimate body iron stores and guide IVFE therapy for long-term HD patients.
Yen-Cheng Chen; Szu-Chun Hung; Der-Cherng Tarng
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  47     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2006 Jun 
Date Detail:
Created Date:  2006-05-29     Completed Date:  2006-06-09     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1036-44     Citation Subset:  IM    
Institutes of Physiology and Clinical Medicine, Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
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MeSH Terms
Anemia, Iron-Deficiency / blood,  diagnosis*,  drug therapy,  etiology
Biological Markers / blood
Bone Marrow / pathology
C-Reactive Protein / analysis
Diagnostic Tests, Routine / methods,  statistics & numerical data*
Erythropoietin / administration & dosage,  therapeutic use
Ferritins / blood*
Hemoglobins / analysis
Injections, Intravenous
Kidney Failure, Chronic / blood,  complications,  drug therapy
Middle Aged
Predictive Value of Tests
Prospective Studies
Receptors, Transferrin / blood*
Renal Dialysis / methods*
Sensitivity and Specificity
Time Factors
Reg. No./Substance:
0/Biological Markers; 0/Hemoglobins; 0/Receptors, Transferrin; 11096-26-7/Erythropoietin; 9007-41-4/C-Reactive Protein; 9007-73-2/Ferritins

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