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Association between common iron store markers and hemoglobin in children with chronic kidney disease

Meredith A Atkinson1, Christopher B Pierce, Jeffrey J Fadrowski

  • 1Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. matkins3@jhmi.edu

Pediatric Nephrology (Berlin, Germany)
|July 28, 2012
PubMed

Insights

In children with chronic kidney disease (CKD), high serum ferritin levels are linked to lower hemoglobin (HGB). Low serum iron with normal/high ferritin may indicate iron-restricted erythropoiesis.

Area of Science:

  • Pediatric Nephrology
  • Hematology
  • Chronic Kidney Disease Research

Background:

  • Assessing iron status in pediatric chronic kidney disease (CKD) is crucial for managing hemoglobin (HGB) levels.
  • Current markers like serum ferritin and transferrin saturation (TSAT) have unclear sensitivity for predicting lower HGB in children with CKD.

Purpose of the Study:

  • To evaluate the association between iron status markers and HGB percentiles in children with mild-to-moderate CKD.
  • To identify key iron status indicators and clinical factors linked to lower HGB levels in this population.

Main Methods:

  • Analysis of iron status markers (ferritin, TSAT, serum iron) in 304 children from the CKiD Study.
  • Examination of HGB percentile values against KDOQI-defined thresholds for ferritin (≥100 ng/ml) and TSAT (≥20%).
  • Utilized regression tree analysis to pinpoint markers most associated with lower HGB percentiles.

Main Results:

  • Higher serum ferritin (≥100 ng/ml) was associated with lower HGB percentile values.
  • TSAT (≥20%) showed only a modest association with increased HGB percentile.
  • Lower glomerular filtration rate (GFR), serum iron <50 μg/dl, and ferritin ≥100 ng/ml were strongly linked to lower HGB percentile.

Conclusions:

  • GFR is significantly associated with HGB levels in pediatric CKD.
  • Elevated serum ferritin correlates with reduced HGB in this cohort.
  • Low serum iron, in the presence of normal/high ferritin and low HGB, may signal iron-restricted erythropoiesis.
Abstract

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