Can the Response to Iron Therapy Be Predicted in Anemic Nondialysis Patients with Chronic Kidney Disease?

Anemia is iron responsive in 30 to 50% of nondialysis patients with chronic kidney disease (CKD), but the utility of bone marrow iron stores and peripheral iron indices to predict the erythropoietic response is not settled. We investigated the accuracy of peripheral and central iron indices to predi...

Full description

Saved in:
Bibliographic Details
Published in:Clinical journal of the American Society of Nephrology 2010-03, Vol.5 (3), p.409-416
Main Authors: Stancu, Simona, Barsan, Liliana, Stanciu, Ana, Mircescu, Gabriel
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Anemia, Iron-Deficiency - blood
Anemia, Iron-Deficiency - drug therapy
Anemia, Iron-Deficiency - etiology
Biomarkers - blood
Blood Chemical Analysis
Bone Marrow - drug effects
Bone Marrow - metabolism
Bone Marrow Examination
Chi-Square Distribution
Chronic Disease
Erythropoiesis - drug effects
Female
Ferric Compounds - administration & dosage
Ferric Compounds - metabolism
Ferritins - blood
Glucaric Acid
Hematinics - administration & dosage
Hematinics - metabolism
Hemoglobins - metabolism
Humans
Iron - blood
Kidney Diseases - blood
Kidney Diseases - complications
Logistic Models
Male
Middle Aged
Original
Predictive Value of Tests
Time Factors
Transferrin - metabolism
Treatment Outcome
Young Adult
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Anemia is iron responsive in 30 to 50% of nondialysis patients with chronic kidney disease (CKD), but the utility of bone marrow iron stores and peripheral iron indices to predict the erythropoietic response is not settled. We investigated the accuracy of peripheral and central iron indices to predict the response to intravenous iron in nondialysis patients with CKD and anemia. A diagnostic study was conducted on 100 nondialysis patients who had CKD and anemia and were erythropoiesis-stimulating agent and iron naive. Bone marrow iron stores were evaluated by aspiration. Hemoglobin, transferrin saturation index (TSAT), and ferritin were measured at baseline and 1 month after 1000 mg of intravenous iron sucrose. Posttest predictive values for the erythropoietic response (> or =1-g/dl increase in hemoglobin) of peripheral and central iron indices were calculated. The erythropoietic response was noted in a higher proportion in bone marrow iron-deplete than in iron-replete patients (63 versus 30%). Peripheral iron indices had a moderate accuracy in predicting response. The positive (PPV) and negative predictive values (NPV) were 76 and 72% for a TSAT of 15% and 74 and 70% for a ferritin of 75 ng/ml, respectively. In the final logistic regression model, including TSAT and ferritin, the chances of a positive response increased by 7% for each 1% decrease in TSAT. Because an erythropoietic response is seen in half of patients and even one third of those with iron-replete stores responded whereas peripheral indices had only a moderate utility in predicting response, the therapeutic trial to intravenous iron seems to be a useful tool in the management of anemia in nondialysis patients with CKD.
ISSN:1555-9041
1555-905X
DOI:10.2215/CJN.04280609