title: Assessing the Association between Serum Ferritin, Transferrin Saturation, and C-Reactive Protein in Northern Territory Indigenous Australian Patients with High Serum Ferritin on Maintenance Haemodialysis.
abstract: Objective. To determine the significance of high serum ferritin observed in Indigenous Australian patients on maintenance haemodialysis in the Northern Territory, we assessed the relationship between ferritin and transferrin saturation (TSAT) as measures of iron status and ferritin and C-reactive protein (CRP) as markers of inflammation.Methods. We performed a retrospective cohort analysis of data from adult patients (≥18 years) on maintenance haemodialysis (>3 months) from 2004 to 2011.Results. There were 1568 patients. The mean age was 53.9 (11.9) years. 1244 (79.3%) were Indigenous. 44.2% (n= 693) were male. Indigenous patients were younger (mean age [52.3 (11.1) versus 57.4 (15.2),p< 0.001]) and had higher CRP [14.7 mg/l (7-35) versus 5.9 mg/l (1.9-17.5),p< 0.001], higher median serum ferritin [1069µg/l (668-1522) versus 794.9µg/l (558.5-1252.0),p< 0.001], but similar transferrin saturation [26% (19-37) versus 28% (20-38),p= 0.516]. We observed a small positive correlation between ferritin and TSAT (r2= 0.11,p< 0.001), no correlation between ferritin and CRP (r2= 0.001,p< 0.001), and positive association between high serum ferritin and TSAT (p< 0.001), Indigenous ethnicity (p< 0.001), urea reduction ratio (p= 0.001), and gender (p< 0.001) after adjustment in mixed regression analysis.Conclusion. Serum ferritin and TSAT may inadequately reflect iron status in this population. The high ferritin was poorly explained by inflammation.
authors.affiliation: Royal Darwin Hospital, Department of Nephrology, Division of Medicine, Tiwi, Darwin, NT, Australia; Northern Territory Medical Programme, Flinders University School of Medicine, Tiwi, Darwin, NT, Australia; Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.
authors.forename: Sandawana William
authors.identifier: 0000-0003-0039-1913
authors.initials: SW
authors.lastname: Majoni
authors.affiliation: Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Lawton
authors.affiliation: Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.
authors.forename: Federica
authors.initials: F
authors.lastname: Barzi
authors.affiliation: Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
authors.affiliation: Royal Darwin Hospital, Department of Nephrology, Division of Medicine, Tiwi, Darwin, NT, Australia; Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.
authors.forename: Jaquelyne T
authors.initials: JT
authors.lastname: Hughes