Pediatric Nephrology

, Volume 27, Issue 12, pp 2275–2283

Association between common iron store markers and hemoglobin in children with chronic kidney disease

  • Meredith A. Atkinson
  • Christopher B. Pierce
  • Jeffrey J. Fadrowski
  • Nadine M. Benador
  • Colin T. White
  • Martin A. Turman
  • Cynthia G. Pan
  • Alison G. Abraham
  • Bradley A. Warady
  • Susan L. Furth
Original Article

DOI: 10.1007/s00467-012-2266-x

Cite this article as:
Atkinson, M.A., Pierce, C.B., Fadrowski, J.J. et al. Pediatr Nephrol (2012) 27: 2275. doi:10.1007/s00467-012-2266-x

Abstract

Background

Serum ferritin and transferrin saturation (TSAT) are used to assess iron status in children with chronic kidney disease (CKD), but their sensitivity in identifying those at risk of lower hemoglobin (HGB) values is unclear.

Methods

We assessed the association of iron status markers (ferritin, TSAT, and serum iron) with age- and gender-related HGB percentile in mild-to-moderate CKD in 304 children in the Chronic Kidney Disease in Children (CKiD) Study. Standardized HGB percentile values were examined by KDOQI-recommended ferritin (≥100 ng/ml) and TSAT (≥20 %) thresholds. Regression tree methods were used to identify iron status markers and clinical characteristics most associated with lower HGB percentiles.

Results

The cohort was 62 % male, 23 % African American, and 12 % Hispanic, median age 12 years, and median HGB 12.9 g/dl. 34 % had low TSAT and 93 % low ferritin as defined by KDOQI. Distribution of HGB percentile values was lower in those with ferritin ≥100 ng/ml, while TSAT ≥20 % was associated with only modest increase in HGB percentile. In regression tree analysis, lower glomerular filtration rate (GFR), serum iron <50 μg/dl and ferritin ≥100 ng/ml were most strongly associated with lower HGB percentile.

Conclusions

The level of GFR was significantly associated with HGB. Higher serum ferritin was associated with lower HGB in this cohort. Low serum iron in the context of normal/increased ferritin and low HGB may be a useful indicator of iron-restricted erythropoiesis.

Keywords

Chronic kidney diseaseHemoglobinIron deficiencyAnemia

Copyright information

© IPNA 2012

Authors and Affiliations

  • Meredith A. Atkinson
    • 1
    • 9
  • Christopher B. Pierce
    • 2
  • Jeffrey J. Fadrowski
    • 1
  • Nadine M. Benador
    • 3
  • Colin T. White
    • 4
  • Martin A. Turman
    • 5
  • Cynthia G. Pan
    • 6
  • Alison G. Abraham
    • 2
  • Bradley A. Warady
    • 7
  • Susan L. Furth
    • 8
  1. 1.Department of PediatricsJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Department of Pediatrics, Division of Pediatric NephrologyUniversity of California, San DiegoSan DiegoUSA
  4. 4.Division of Nephrology, BC Children’s HospitalUniversity of British ColumbiaVancouverCanada
  5. 5.Department of Pediatrics, Division of NephrologyUniversity of Oklahoma Health Sciences CenterOklahoma CityUSA
  6. 6.Department of PediatricsMedical College of WisconsinMilwaukeeUSA
  7. 7.Department of Pediatrics, Children’s Mercy HospitalUniversity of Missouri-Kansas City School of MedicineKansas CityUSA
  8. 8.Department of PediatricsChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  9. 9.Pediatric NephrologyJohns Hopkins UniversityBaltimoreUSA