The fascinating but deceptive ferritin: To measure it or not to measure it in chronic kidney disease?
The fascinating but deceptive ferritin: To measure it or not to measure it in chronic kidney disease?
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DOI：
10.2215/cjn.01390406
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发表时间：
2006-09-01
影响因子：
9.8
通讯作者：
Lee, Grace H.
中科院分区：
文献类型：
--
作者：
Kalantar-Zadeh, Kamyar;Kalantar-Zadeh, Kourosh;Lee, Grace H.
尽管红细胞生成刺激剂的出现在过去二十年彻底改变了慢性肾病 (CKD) 的贫血治疗，但评估铁 (Fe) 状况和提供铁补充剂的策略仍然不明确。前红细胞生成刺激剂时代的透析患者血色素沉着症病例报道，以及铁与感染和氧化应激可能存在的关联，加剧了“铁恐惧”。迄今为止，尚未就 CKD 中铁储存的可靠标记达成一致。血清铁蛋白仍然是人们关注的焦点。几乎一半的维持性血液透析患者的血清铁蛋白>500 ng/ml。在此铁蛋白范围内，目前不鼓励补充铁，尽管大多数报道的血色素沉着症病例的血清铁蛋白>2000 ng/ml。中度高铁蛋白血症（500 至 2000 ng/ml）似乎主要是由非铁相关疾病引起，包括炎症、营养不良、肝病、感染和恶性肿瘤。最近的流行病学研究表明，低血清铁而不是高血清铁与维持性血液透析患者的生存率较差有关。在减轻营养不良-炎症混杂影响的多变量调整模型中，血清铁蛋白
Although the emergence of erythropoiesis-stimulating agents has revolutionized the anemia management of chronic kidney disease (CKD) in the past two decades, strategies to assess iron (Fe) status and to provide Fe supplementation have remained indistinct. The reported cases of hemochromatosis in dialysis patients from the pre-erythropoiesis-stimulating agent era along with the possible associations of Fe with infection and oxidative stress have fueled the "iron apprehension." To date, no reliable marker of Fe stores in CKD has been agreed on. Serum ferritin continues to be the focus of attention. Almost half of all maintenance hemodialysis patients have a serum ferritin >500 ng/ml. In this ferritin range, Fe supplementation currently is not encouraged, although most reported hemochromatosis cases had a serum ferritin >2000 ng/ml. The moderate-range hyperferritinemia (500 to 2000 ng/ml) seems to be due mostly to non-Fe-related conditions, including inflammation, malnutrition, liver disease, infection, and malignancy. Recent epidemiologic studies have shown that a low, rather than a high, serum Fe is associated with a poor survival in maintenance hemodialysis patients. In multivariate adjusted models that mitigate the confounding effect of malnutrition-inflammation, serum ferritin