Soluble Transferrin Receptor and Soluble Transferrin Receptor/Log Ferritin Ratio are Correlated with Iron Status in Regular Hemodialysis Patients

Yenny Kandarini, Gede Wira Mahadita, Sianny Herawati, Anak Agung Wiradewi Lestari, Ketut Suega, I Gde Raka Widiana

Abstract


BACKGROUND: Monitoring of iron status in chronic kidney disease patients is important, however inflammation may hinder its monitoring. Soluble transferrin receptor (sTfR) is an alternative parameter to overcome this issue, whereas ferritin play a part in the inflammation process. Hence, the correlation between the sTfR ratio and the sTfR/log ferritin ratio with conventional iron status parameters in regular hemodialysis patients is necessary to be evaluated.

METHODS: A cross-sectional was conducted in the current study. As many as 5 mL of blood (2 mL for sTfR and 3 mL for serum iron and ferritin levels) was collected. sTfR level was the blood-soluble transferrin receptor level measured by the enzyme-linked immunosorbent assay (ELISA). The amount of ferritin and serum iron was determined using the immunochemiluminescent process. To evaluate the correlation, the Pearson correlation test was used.

RESULTS: A total of 80 subjects was included in this study. The mean of hemoglobin was 10.25±1.66 g/dL, serum iron was 58.19±26.56 g/dL, and the median ferritin was 520.4 (49.9-3606) ng/mL. The sTfR was significantly associated only with serum iron levels with a correlation coefficient of r=-0.242; p=0.031. The sTfR/log ferritin was significantly associated with serum iron l evels (InSI)(r=-0.255, p=0.022); and transferrin saturation (r=-0.295; p=0.008).

CONCLUSION: sTfR/log ferritin has a negative and significant correlation with serum iron levels and transferrin saturation, while sTfR negatively correlated with serum iron levels. sTfR and sTfR/log ferritin may be considered as an alternative iron marker in inflammation setting such as CKD.

KEYWORDS: sTfR/log ferritin, iron status, serum iron, ferritin, chronic kidney disease, hemodialysis


Full Text:

PDF

References


Bello AK, Levin A, Tonelli M, Okpechi IG, Feehally J, Harris D, et al. Global Kidney Health Atlas: A report by the International Society of Nephrology on the current state of organization and structures for kidney care across the globe. Brussels: International Society of Nephrology; 2017, article.

Urrechaga E, Borque L, Escanero J. Assessing iron status in CKD patients: new laboratory parameters. In: Monika Göőz, editor. Chronic Kidney Disease. London: InTech Open; 2012, CrossRef.

Koulaouzidis A, Said E, Cottier R, Saeed AA. Soluble transferrin receptors and iron deficiency, a step beyond ferritin. A systematic review. J Gastrointestin Liver Dis. 2009; 18: 345-52, PMID.

Infusino I, Braga F, Dolci A, Panteghini M. Soluble transferrin receptor (sTfR), and sTfR/log ferritin index for the diagnosis of iron-deficiency anemia a meta-analysis. Am J Clin Pathol. 2012; 138: 642-9, CrossRef.

Beerenhout, C, Bekers O, Kooman JP, van der Sande FM, Leunissen KML. A comparison between the soluble transferrin receptor, transferrin saturation, and serum ferritin as markers of iron state in hemodialysis patients. Nephron. 2002; 92: 32-5, CrossRef.

Gaweda AE. Markers of iron status in chronic kidney disease. Hemodial Int. 2017; 21: S21-7, CrossRef.

Gupta D, Choudhary R, Sharma M, Saluja SGB. Role of soluble transferrin receptor and soluble transferrin receptor index in diagnosing iron deficiency anemia in patients with chronic kidney disease. Astrocyte. 2016; 3: 125-30, CrossRef.

Skikne BS, PunnonenK, Caldron PH, Bennett MT, Rehu M, Gasior GH, et al. Improved differential diagnosis of anemia of chronic disease and iron deficiency anemia: A prospective multicenter evaluation of soluble transferrin receptor and the sTfR/log ferritin index. Am J Hematol. 2011; 86: 923-7, CrossRef.

Kurzawa T, Owczarek A, Strzelczyk J, Gołąbek K, Wiczkowski A. The content of reticulocyte hemoglobin and serum concentration of the soluble transferrin receptor for diagnostics of anemia in chronically hemodialyzed patients. Adv Clin Exp Med. 2016; 25: 425-31, CrossRef.

Bahrainwala J, Berns JS. Diagnosis of iron-deficiency anemia in chronic kidney disease. Semin Nephrol. 2016; 36: 94-8, CrossRef.

Chen Y, Hung S, Tarng D. Association between transferrin receptor–ferritin index and conventional measures of iron responsiveness in hemodialysis patients. Am J Kidney Dis. 2006; 47: 1036-44, CrossRef.

Oustamanolakis P, Koutroubakis IE, Messaritakis I. Soluble transferrin receptor-ferritin index in the evaluation of anemia in inflammatory bowel disease : a case-control study. Ann Gastroenterol. 2011; 24: 108-14, PMID.

Tijanić I, Vučić M, Golubović LM. The significance of soluble transferrin receptors in diagnosing iron deficiency anemia. Rev Rom Med. 2015; 23: 275-84, CrossRef.

Dhingra R, Gona P, Nam BH, D’Agostino RB, Wilson PWF, Benjamin EJ, et al. C-reactive protein, inflammatory conditions, and cardiovascular disease risk. Am J Med. 2007; 120: 1054-62, CrossRef.

Kadariswantiningsih IN, Thaha M, Nugroho CW, Hamidah B, Rasyid H, Hakim ZE, et al. Could complete blood count parameters and non-fasting cholesterol profile describe inflammation and oxidative stress in chronic kidney disease?. Indones Biomed J. 2018; 10: 270-7, CrossRef.

Heidari B. C-reactive protein and other markers of inflammation in hemodialysis patients. Caspian Journal of Internal Medicine. 2013; 4: 611-6, PMID.

Kalantar-Zadeh K, Rodriguez RA, Humphreys MH. Association between serum ferritin and measures of inflammation, nutrition, and iron in hemodialysis patients. Nephrol Dial Transplant. 2004; 19: 141-9, CrossRef.

Nurfina W, Yusuf I, Arif M. Correlation of ferritin and transferrin serum with hsCRP and F2-isoprostane in metabolic syndrome. Indones Biomed J. 2010; 2: 131-6, CrossRef.




DOI: https://doi.org/10.18585/inabj.v13i2.1412

Indexed by:

                 

                  

               

     

 

The Prodia Education and Research Institute