Serum ferritin level remains a reliable marker of bone marrow iron stores evaluated by histomorphometry in hemodialysis patients.
OBJECTIVE
As well as being a marker of body iron stores, serum ferritin (sFerritin) has also been shown to be a marker of inflammation in hemodialysis (HD) patients. The aim of this study was to analyze whether sFerritin is a reliable marker of the iron stores present in bone marrow of HD patients.


METHODS
Histomorphometric analysis of stored transiliac bone biopsies was used to assess iron stores by determining the number of iron-stained cells per square millimeter of bone marrow.


RESULTS
In 96 patients, the laboratory parameters were hemoglobin = 11.3 +/- 1.6 g/dl, hematocrit = 34.3 +/- 5%, sFerritin = 609 +/- 305 ng/ml, transferrin saturation = 32.7 +/- 22.5%, and C-reactive protein (CRP) = 0.9 +/- 1.4 mg/dl. sFerritin correlated significantly with CRP, bone marrow iron, and time on HD treatment (P = 0.006, 0.001, and 0.048, respectively). The independent determinants of sFerritin were CRP (beta-coef = 0.26; 95% CI = 24.6 to 132.3) and bone marrow iron (beta-coef = 0.32; 95% CI = 0.54 to 2.09). Bone marrow iron was higher in patients with sFerritin >500 ng/ml than in those with sFerritin < or =500 ng/ml. In the group of patients with sFerritin < or =500 ng/ml, the independent determinant of sFerritin was bone marrow iron (beta-coef = 0.48, 95% CI = 0.48 to 1.78), but in the group of patients with sFerritin >500 ng/ml, no independent determinant of sFerritin was found.


CONCLUSIONS
sFerritin adequately reflects iron stores in bone marrow of HD patients.
Division of Nephrology, Department of Internal Medicine, Federal University of São Paulo, São Paulo, SP, Brazil.
Lillian A
LA
Rocha
Daniela V
DV
Barreto
Fellype C
FC
Barreto
Cristiane B
CB
Dias
Rosa
R
Moysés
Maria Regina R
MR
Silva
Luiz A R
LA
Moura
Sérgio A
SA
Draibe
Vanda
V
Jorgetti
Aluízio B
AB
Carvalho
Maria Eugênia F
ME
Canziani
D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D001853:Bone Marrow / Q000737:chemistry* / Q000473:pathology; D001856:Bone Marrow Examination; D002097:C-Reactive Protein / Q000032:analysis; D002452:Cell Count; D003430:Cross-Sectional Studies; D005260:Female; D005293:Ferritins / Q000097:blood*; D006454:Hemoglobins / Q000032:analysis; D006651:Histocytochemistry / Q000379:methods; D006801:Humans; D007501:Iron / Q000032:analysis*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D006435:Renal Dialysis / Q000009:adverse effects*; D015203:Reproducibility of Results; D013194:Staining and Labeling; D014168:Transferrin / Q000032:analysis
D015415:Biomarkers; D006454:Hemoglobins; D014168:Transferrin; D002097:C-Reactive Protein; D005293:Ferritins; D007501:Iron