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Serum Ferritin Level Remains a Reliable Marker of Bone Marrow Iron Stores Evaluated by Histomorphometry in Hemodialysis Patients

Lillian A. Rocha^*, Daniela V. Barreto^*, Fellype C. Barreto^*, Cristiane B. Dias, Rosa Moysés, Maria Regina R. Silva, Luiz A. R. Moura, Sérgio A. Draibe^*, Vanda Jorgetti, Aluízio B. Carvalho^*, and Maria Eugênia F. Canziani^*

Divisions of ^* Nephrology and Pathology, Department of Internal Medicine, Federal University of São Paulo, and Division of Nephrology, Department of Internal Medicine, University of São Paulo, São Paulo, Brazil

Correspondence: Maria Eugênia F Canziani, R. Pedro de Toledo, 282. São Paulo, SP, Brazil 04039-000. Phone: +55-11-55713261; Fax: +55-11-55721862; E-mail: dialisefor{at}uol.com.br

Background and objectives: As well as being a marker of body iron stores, serum ferritin (sFerritin) has also been shown to be a marker of inflammation in hemodialysis (HD) patients. The aim of this study was to analyze whether sFerritin is a reliable marker of the iron stores present in bone marrow of HD patients.

Design: Histomorphometric analysis of stored transiliac bone biopsies was used to assess iron stores by determining the number of iron-stained cells per square millimeter of bone marrow.

Results: In 96 patients, the laboratory parameters were hemoglobin = 11.3 ± 1.6 g/dl, hematocrit = 34.3 ± 5%, sFerritin = 609 ± 305 ng/ml, transferrin saturation = 32.7 ± 22.5%, and C-reactive protein (CRP) = 0.9 ± 1.4 mg/dl. sFerritin correlated significantly with CRP, bone marrow iron, and time on HD treatment (P = 0.006, 0.001, and 0.048, respectively). The independent determinants of sFerritin were CRP (β-coef = 0.26; 95% CI = 24.6 to 132.3) and bone marrow iron (β-coef = 0.32; 95% CI = 0.54 to 2.09). Bone marrow iron was higher in patients with sFerritin >500 ng/ml than in those with sFerritin 500 ng/ml. In the group of patients with sFerritin 500 ng/ml, the independent determinant of sFerritin was bone marrow iron (β-coef = 0.48, 95% CI = 0.48 to 1.78), but in the group of patients with sFerritin >500 ng/ml, no independent determinant of sFerritin was found.

Conclusions: sFerritin adequately reflects iron stores in bone marrow of HD patients.

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Clin. J. Am. Soc. Nephrol. 2009 4: 14-15. [Full Text] [PDF]

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