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Abstract: TH-PO256

Role of Soluble Transferrin Receptors, Serum Ferritin, and Inflammatory Markers in Assessment of Functional Iron Deficiency in Anemia of CKD

Session Information

Category: Anemia and Iron Metabolism

  • 201 Anemia and Iron Metabolism: Basic

Authors

  • Kalra, Om Parkash, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
  • Garg, Neha, University College of Medical Sciences and GTB Hospital, Delhi, India
  • Yadav, Anil Kumar, University College of Medical Sciences and GTB Hospital, Delhi, India
  • Rusia, Usha, University College of Medical Sciences and GTB Hospital, Delhi, India
  • Sikka, Meera, University College of Medical Sciences and GTB Hospital, Delhi, India
  • Kotru, Mrinalini, University College of Medical Sciences and GTB Hospital, Delhi, India
Background

Anemia in chronic kidney disease (CKD) is multifactorial and functional iron deficiency (FID) is very common. The presence of coexisting inflammation may alter transferrin saturation (TSAT) and serum ferritin (SF) values, thus affecting their utility in assessment of iron stores. Interleukin-6 (IL-6) is the prime mediator of FID through hepcidin induction and has a direct role in the pathogenesis of anemia in CKD. The present study was conducted to explore the role of soluble transferrin receptors (sTfR), SF, IL-6 and high-sensitive C- reactive protein (hsCRP) in anemia of CKD. ESR was measured by Westergren method.

Methods

A total of 77 patients of CKD {Stage 3 (n=31), 4 (n=17) and 5 (n=29)} of either sex, aged >18 years with hemoglobin (Hb) <11 g/dL were studied. Patients with active bleed, chronic infection, systemic disorders, history of recent blood transfusion and those receiving iron supplements were excluded. Hb, serum iron (SI), total iron binding capacity (TIBC) were measured in all the cases and TSAT was calculated. SF, sTfR, hsCRP and IL-6 were measured by ELISA technique.

Results

Taking sTfR/log ferritin (cut-off >1) as gold standard, CKD patients were divided into two groups:- Group-A: Iron deficient erythropoiesis (IDE) (n=31) and Group-B: Non-iron deficient erythropoiesis (NIDE) (n=46). No statistically significant difference was found in the values of Hb, MCV, MCH, MCHC, SI, TIBC, TSAT and SF between the two groups. All patients had raised IL-6 while hsCRP was raised in 60/77 (79.93%) patients. A positive correlation was found between hsCRP and SF (r=0.311, p=0.006) and between ESR and SF (r=0.451, p=0.000); however, no correlation was found with sTfR, indicating that sTfR levels are not affected by inflammation. The criteria i.e. TSAT <20% and SF>100 μg/L showed a sensitivity of only 6.45% in detection of FID. On the other hand, SF levels from 12 to 70 μg/L were able to identify 14/19 (73.7%) cases of FID. Further, sTfR showed significantly higher values in the IDE group (p=0.000).

Conclusion

hsCRP, ESR and IL-6 levels were raised in majority of the patients of CKD with anemia and were not useful in the diagnosis of FID; however, raised sTfR levels and SF values between 12 to 70 μg/L were found to be useful for assessment of IDE (p=0.000).