diagnostic tests to determine iron status and predict response to iron therapy in CKD
carry out testing to diagnose iron deficiency and determine potential responsiveness to iron therapy and long-term iron requirements every 3 months (every 1-3 months for people receiving haemodialysis)
percentage of hypochromic red blood cells (% HRC; more than 6%) should be used, but only if processing of blood sample is possible within 6 hours
if using percentage of hypochromic red blood cells is not possible, use reticulocyte haemoglobin (Hb) content (CHr; less than 29 pg) or equivalent tests - for example, reticulocyte Hb equivalent
only if these tests are not available or the person has thalassaemia or thalassaemia trait, use a combination of transferrin saturation (less than 20%) and serum ferritin measurement (less than 100micrograms/litre)
therefore a clinician should not routinely request transferrin saturation or serum ferritin measurement alone to assess iron deficiency status in people with anaemia of chronic kidney disease (CKD)
measurement of erythropoietin levels for the diagnosis or management of anaemia should not be routinely considered for people with anaemia of CKD
Note:
serum ferritin is an acute-phase reactant and frequently raised in CKD, the diagnostic cut-off value should be interpreted differently to non-CKD patients
in people treated with iron, serum ferritin levels should not rise above 800 micrograms/litre. In order to prevent this, review the dose of iron when serum ferritin levels reach 500micrograms/litre
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