Markers of iron status in chronic kidney disease.
Markers of iron status in chronic kidney disease.
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DOI：
10.1111/hdi.12556
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发表时间：
2017-06
期刊：
影响因子：
--
通讯作者：
Gaweda AE
中科院分区：
文献类型：
--
作者：
Gaweda AE
贫血是与慢性肾脏病（CKD）相关的主要合并症之一。在红细胞生成刺激剂 (ESA) 出现之前，内源性红细胞生成素缺乏一直被认为是 CKD 患者贫血的主要原因。 ESA 的使用为 CKD 贫血的生理学提供了新的线索，其中铁稳态发挥着越来越重要的作用。 CKD 中发生的铁稳态紊乱将这些患者的贫血管理变成了一项复杂的多因素治疗任务，其中 ESA 和铁剂量必须适当平衡，以实现预期的结果，而不会使患者面临严重不良事件的风险。本综述涵盖了传统上用于量化 CKD 患者铁状态的诊断标志物（例如血清铁蛋白和转铁蛋白饱和度）、新标志物（例如网织红细胞血红蛋白含量和低色素红细胞百分比）以及实验标志物（例如铁调素和可溶性转铁蛋白受体）。每个标记都以其诊断性能来呈现，然后是生物学和分析变异性数据。简要讨论了每个标记的优点和缺点。尽管血清铁蛋白和转铁蛋白饱和度很容易获得，但它们表现出很大的生物学变异性，在用于诊断 CKD 患者的铁状态时需要谨慎。网织红细胞血红蛋白含量和低色素红细胞百分比更强大，但其广泛使用受到样品储存稳定性问题的阻碍。可溶性转铁蛋白受体和铁调素显示出前景，但需要进一步研究以及标准化、低成本检测平台的开发。
Anemia is one of the main comorbidities related to Chronic Kidney Disease (CKD). Until the advent of Erythropoiesis Stimulating Agents (ESA), endogenous erythropoietin deficiency has been thought to be the main culprit of anemia in CKD patients. The use of ESA’s has shed new light on the physiology of CKD anemia, where iron homeostasis plays an increasingly important role. Disorders of iron homeostasis occurring in CKD turn the anemia management in those patients into a complex multifactorial therapeutic task, where ESA and Iron dose must be properly balanced to achieve the desired outcome without exposing the patients to the risk of serious adverse events. This review covers diagnostic markers traditionally used for quantifying iron status in CKD patients, such as serum ferritin and transferrin saturation, new ones, such as reticulocyte hemoglobin content and percent hypochromic red cells, as well as experimental ones, such as hepcidin and soluble transferrin receptor. Each marker is presented in terms of their diagnostic performance, followed by biological and analytical variability data. Advantages and disadvantages of each marker are briefly discussed. Although serum ferritin and transferrin saturation are easily available, they exhibit large biological variability and require caution when used for diagnosing iron status in CKD patients. Reticulocyte hemoglobin content and the percentage of hypochromic red cells are more powerful, but their widespread use is hampered by the issue of sample stability in storage. Soluble transferrin receptor and hepcidin show promise, but require further investigation as well as the development of standardized, low-cost assay platforms.
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作者：
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