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Soluble transferrin receptor and transferrin receptor-ferritin index in anemia of chronic renal failure

Objective: Conventional hematologic and biochemical parameters are often unhelpful in assessment of iron status in patients with anemia of chronic renal failure (ACRF). The aim of the study was to assess the values of soluble transferrin receptor (sTfR) and transferrin receptor-ferritin index (sTfR/logF), as new markers of iron status, in ACRF patients treated and not treated with recombinant human erythropoietin (rHuEPO). Patients and Methods: The study included 53 patients with ACRF and 61 healthy controls. The concentration of sTfR was determined by particle-enhanced immunoturbidimetric assay (Orion Diagnostica, Finland). sTfR/logF index was calculated as the ratio of sTfR to logarithm ferritin level. Results: Unlike all conventional hematologic and biochemical parameters tested, sTfR and sTfR/logF values were significantly higher in patients receiving rHuEPO (p=0.018 ; p=0.043). There were statistically significant positive correlations of sTfR and sTfR/logF values with endogenous erythropoietin concentrations in ACRF patients not receiving rHuEPO (r=0.668, r=0.690, p<0.001). In contrast to ferritin concentrations that showed significant differences between patients with normal and elevated C-reactive protein (CRP) (p=0.045), sTfR and sTfR/logF parameters didn't show significant differences (p=0.108 ; p=0.147). Conclusion: The results suggest that besides iron deficiency, erythropoietin is an important stimulus for TfR synthesis and expression. The results indicated the tested parameters could be used to help evaluate iron status in patients with ACRF. In contrast to serum ferritin that may be nonspecifically increased irrespective of iron status as an acute phase protein, sTfR appears not to behave as an acute phase reactant and not to be influenced by inflammation. Further studies are needed to evaluate the possible application of sTfR and sTfR/logF parameters in predicting an erythroid response to rHuEPO therapy.

soluble transferrin receptor; transferrin receptor-ferritin index; human erythropoietin; anemia of chronic renal failure

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