Table 3.

Our recommended interpretation of serum ferritin levels in CKD patients who undergo maintenance dialysis treatment

Serum Ferritin Range (ng/ml)
Ferritin <200Ferritin >200 and <500Ferritin >500 and <2000Ferritin >2000
Common conditions in CKDAbsolute Fe deficiency (most common), ferritin deficiency syndromebMay be associated with both absolute and functional Fe deficiency.Most commonly associated with inflammation, infection, liver disease, or malignancy.Fe overload overwhelms the effect of inflammation on serum ferritin.
Association with Fe stores↓ferritin←→↓Fe↑ferritin←?→↓↑Fe↑↑ferritin←?→↓↑Fe↑↑↑ferritin←→↑Fe
What serum ferritin meansSerum ferritin = FeSerum ferritin = inflammation + Fe + othersSerum ferritin = inflammation + Fe + othersSerum ferritin = Fe
Recommended course of actionFe supplementationMaintenance Fe supplementation is indicated if ISAT <50%Check serum CRP, liver enzyme, assess MIS, and rule out latent infection or malignancies. If ESA resistance persists, then Fe administration may be beneficial if ISAT <50%Fe supplementation should be avoided.
  • aAdapted from reference (32). CRP, C-reactive protein; ESA, erythropoiesis-stimulating agent; MIS, malnutrition-inflammation score.

  • b The ferritin deficiency syndrome can be present if serum ferritin level is <50 ng/ml (see text).