OBJECTIVE: In ESRD patients with chronic dialysis, increased iron losses, reduced iron absorption, and limited iron availability leads to iron deficiency. Intravenous iron therapy is frequently given to restore lost iron, but determining iron status can be challenging and imprecise, leading to risk of iron overload in patients. This study was aimed to assess iron status in pediatric ESRD patients on hemodialysis.
METHOD: Retrospective data regarding serum iron, ferritin, transferrin saturation (TSAT), total iron-binding capacity (TIBC), and hemoglobin (Hb) level were obtained from electronic medical record of pediatric ESRD in Cipto Mangunkusumo hospital during 2017 – 2018.
RESULT: There were 83 ESRD patients included in the study. The considerable anemia (Hb level below 10 g/dL) was present in 51.2% of the patients and treated with erythropoietin and/or blood transfusion. The mean Hb level was 9,8 + 1,97 g/dL. Approximately 20% had functional iron deficiency; none of them had absolute iron deficiency. The mean of  TSAT was 39,8 + 21,9. The mean of ferritin was 1683,9 mcg/L (ranged 88 – 9247). There was no significant association between Hb and ferritin level. Assessment of iron status in CKD patients remains challenging, while high ferritin values may be indicative of increased inflammation, transferrin levels are reduced by inflammation. Iron deposition within the reticuloendothelial system (RES) organs, like liver, cardiac and pancreas appears to greatly increase the risk of tissue damage and subsequent adverse outcomes.
CONCLUSION: Functional iron deficiency is the predominant form of iron deficiency in our dialysis patients. TSAT and serum ferritin were widely used to assess iron status even though they have limitations in terms of specificity and specificity in patients with ESRD. Most patient had ferritin level in ESRD exceeding 1000 mcg/L, indicating the needs of alternative tools for assessing iron deficiency , such as hemoglobin content in reticulocytes (CHr); and for iron overload, such as MRI T2*.