Anaemia is an important complication of renal failure as a result of the loss of the capacity to synthesize erythropoietin. However, iron deficiency is also an important cause of erythropoietin resistance. While ferritin is a good marker of iron status, this is less true in patients with a chronic disease such as renal failure. An alternative proposed marker is soluble transferrin receptor, the level of which is influenced by iron status but not the coexistence of chronic disease.
Daschner and colleagues  have investigated the efficacy of both ferritin and soluble transferrin receptor in the monitoring of erythropoietin and iron therapy in 27 patients on dialysis (11 haemodialysis and 16 peritoneal dialysis). They studied the relationship between erythropoietin requirements and various parameters of erythropoiesis. A significant correlation was shown between the erythro-poietin efficacy index (erythropoietin dose divided by haemoglobin concentration) and soluble transferrin receptor (r = 0.65; p = 0.001), while neither ferritin nor transferrin saturation were indicative of erythropoietin requirement. The authors suggested that intensified iron substitution in patients with elevated levels of soluble transferrin receptor (indicative of iron deficiency) might improve the cost-effectiveness of erythropoietin therapy.
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