The fascinating but deceptive ferritin: To measure it or not to measure it in chronic kidney disease?

被引:152
作者
Kalantar-Zadeh, Kamyar
Kalantar-Zadeh, Kourosh
Lee, Grace H.
机构
[1] Harbor UCLA Med Ctr, Los Angeles Biomed Res Inst, Div Nephrol & Hypertens, Torrance, CA 90502 USA
[2] Harbor UCLA Med Ctr, Los Angeles Biomed Res Inst, Dept Pharm, Torrance, CA 90502 USA
[3] RMIT Univ, Sch Educ & Comp Engn, Ctr Microelect & Mat Technol, Melbourne, Vic 3001, Australia
来源
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2006年 / 1卷
关键词
D O I
10.2215/CJN.01390406
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Although the emergence of erythropoiesis-stimulating agents has revolutionized the anemia management of chronic kidney disease (CKD) in the past two decades, strategies to assess iron (Fe) status and to provide Fe supplementation have remained indistinct. The reported cases of hemochromatosis in dialysis patients from the pre-erythropoiesis-stimulating agent era along with the possible associations of Fe with infection and oxidative stress have fueled the "iron apprehension." To date, no reliable marker of Fe stores in CKD has been agreed on. Serum ferritin continues to be the focus of attention. Almost half of all maintenance hemodialysis patients have a serum ferritin >500 ng/ml. In this ferritin range, Fe supplementation currently is not encouraged, although most reported hemochromatosis cases had a serum ferritin >2000 ng/ml. The moderate-range hyperferritinemia (500 to 2000 ng/ml) seems to be due mostly to non-Fe-related conditions, including inflammation, malnutrition, liver disease, infection, and malignancy. Recent epidemiologic studies have shown that a low, rather than a high, serum Fe is associated with a poor survival in maintenance hemodialysis patients. In multivariate adjusted models that mitigate the confounding effect of malnutrition-inflammation, serum ferritin <1200 ng/ml and Fe saturation ratio in 30 to 50% range are associated with the greatest survival in maintenance hemodialysis patients. Although ferritin is a fascinating molecule, moderate hyperferritinemia is a misleading marker of Fe stores in patients with CKD. It may be time to revisit the utility of serum ferritin in CKD and ask ourselves whether its measurement has helped us or has caused more confusion and controversy.
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页码:S9 / S18
页数:10
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