Renal Failure (Dec 2023)

Bone marrow macrophage iron content and sideroblast count in iron- and ESA-naïve patients with CKD-related anemia

  • Cristina Capusa,
  • Ana-Maria Mehedinti,
  • Liliana Bârsan,
  • Ana Stanciu,
  • Andreea Calenic,
  • Gabriel Mircescu

DOI
https://doi.org/10.1080/0886022X.2023.2230300
Journal volume & issue
Vol. 45, no. 1

Abstract

Read online

AbstractBackground Since in chronic kidney disease (CKD) iron deficiency anemia (IDA) can coexist with inflammation-induced immobilization of iron in macrophages (anemia of chronic disorders – ACD), we assessed the utility of ferritin, transferrin saturation (TSAT), and hepcidin for differentiation of mixed IDA-ACD from ACD, using bone marrow (BM) examination as reference.Methods This cross-sectional, single-center study analyzed 162 non-dialysis iron and epoietin-naïve CKD patients (52% males, median age 67 years, eGFR 14.2 mL/min 1.73 m2, hemoglobin 9.4 g/dL). BM aspiration, serum hepcidin (ELISA), ferritin, TSAT, and C-Reactive protein (CRP) were the main studied parameters.Results ACD was seen in 51%, IDA-ACD in 40%, while “pure” IDA in only 9%. In univariate and binomial analyses, IDA-ACD differed from ACD by lower ferritin and TSAT, but not by hepcidin or CRP. Correspondingly, in receiver operating curve analysis, ferritin and TSAT differentiated IDA-ACD from ACD, at cutoffs of 165 ng/mL and 14%, but with moderate precision (sensitivity and specificity of 72%, and 61%, respectively).Conclusion The mixed pattern IDA-ACD could be more prevalent than estimated in non-dialysis CKD. Ferritin and, to a lesser degree, TSAT are useful in the diagnosis of IDA superimposed on ACD, while hepcidin, although reflecting BM macrophages iron, seems to have limited utility.

Keywords