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[Iron reserves in patients with chronic renal insufficiency]
Insights
Patients with chronic renal failure (CRF) often have altered iron levels. This study found that serum ferritin and a modified desferal test can assess iron reserves, with oral iron drugs suggested for prevention.
Area of Science:
- Nephrology
- Hematology
- Clinical Chemistry
Background:
- Patients with end-stage chronic renal failure (CRF) experience significant blood loss and iron dysregulation.
- Iron overload can occur due to blood transfusions and parenteral iron administration in CRF patients.
Purpose of the Study:
- To determine iron balance in terminal CRF patients.
- To establish criteria for assessing iron reserves using serum ferritin and a modified desferal test.
- To investigate the relationship between iron administration methods and iron levels.
Main Methods:
- Studied 107 terminal CRF patients, including 59 on regular hemodialysis.
- Measured serum iron and ferritin levels, body iron reserves (modified desferal test), and performed histochemical analysis of hemosiderin.
- Correlated iron reserve measurements with iron administration routes (drugs, transfusions).
Main Results:
- A strong correlation (r=0.94) was found between iron reserves (modified desferal test) and serum ferritin levels.
- Patients receiving blood transfusions and parenteral iron had the highest iron reserves.
- Established reference ranges for serum ferritin (50-400 µg/l) and modified desferal test (0.4-2.0/0.5 g) indicating normal iron reserves in CRF.
Conclusions:
- Serum ferritin and the modified desferal test are reliable indicators of iron reserves in renal failure patients.
- Histochemical analysis of tissue hemosiderin is necessary to assess the degree of hemosiderosis.
- Oral iron drugs are recommended for preventing iron balance disorders in CRF patients.
Abstract:
Hemorrhage values and the amount of iron entering the body with drugs and blood transfusions were determined in 107 patients with the terminal CRF stage. Of them 59 received regular hemodialyses. The level of serum iron and ferritin as well as iron reserves in the body were investigated at the start and end of the study. In the end a histochemical study of the content of hemosiderin in the bone marrow, liver and spleen was performed. A close interrelationship of iron reserves determined with a modified desferal test and the level of serum ferritin (r = 0.94) was established. The highest iron reserves were revealed in the patients receiving blood transfusions and parenteral iron drugs. Criteria for the assessment of iron reserves in patients with renal failure were determined by means of the modified desferal test and investigation of serum ferritin. Normal ferritin reserves in such patients corresponded to serum ferritin values within the range of 50-400 micrograms/l and indices of the modified desferal test ranging from 0.4 to 2.0/0.5 g of desferal. Of a degree of hemosiderosis one could judge on the basis of a histochemical investigation of tissue hemosiderin only. Iron drugs per os were proposed for the prevention of disorders of iron balance in patients with renal failure.