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Biomarkers for assessing and managing iron deficiency anemia in late-stage chronic kidney disease |
Chung M, Moorthy D, Hadar N, Salvi P, Iovin RC, Lau J |
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Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Chung M, Moorthy D, Hadar N, Salvi P, Iovin RC, Lau J. Biomarkers for assessing and managing iron deficiency anemia in late-stage chronic kidney disease. Rockville: Agency for Healthcare Research and Quality (AHRQ). Comparative Effectiveness Review No. 83. 2012 Authors' objectives To summarize the literature on the use of newer versus classical laboratory biomarkers of iron status as part of the management strategies for iron deficiency in stages 3–5 CKD patients (nondialysis and dialysis). Authors' conclusions Combining the evidence addressing Key Questions 2, 3, and 4, we can conclude that all currently available laboratory biomarkers of iron status (either newer or classical markers) do not have an ideal predictive ability when used singly to determine iron deficiency as defined by a response to iron challenge test. Furthermore, we can conclude that there is insufficient evidence to determine the test performance of the combinations of newer
biomarkers, or combinations of newer and classical biomarkers, for diagnosing iron deficiency.
However, it may be that CHr and %HYPO have better predictive ability for a response to IV iron treatment than classical markers (TSAT <20 or ferritin <100 ng/mL) in HD CKD patients. In addition, results from two RCTs showed a reduction in the number of iron status tests and resulting IV iron treatments administered to patients whose iron management was guided by CHr, compared with those guided by TSAT or ferritin. These results suggest that CHr may reduce potential harms from IV iron treatment by lowering the frequency of iron testing,
although the evidence for the potential harms associated with testing or test-associated treatment is insufficient.
Nevertheless, the strength of evidence supporting these conclusions is low, and there remains considerable clinical uncertainty regarding the use of newer markers in the assessment of iron status and management of iron deficiency in stages 3–5 CKD patients (both nondialysis and dialysis). In addition, factors that may affect the test performance and clinical utility of newer laboratory markers of iron status remain largely unexamined. Indexing Status Subject indexing assigned by CRD MeSH Anemia, Iron-Deficiency; Biomarkers; Diagnosis, Differentials; Renal Insufficiency, Chronic Language Published English Country of organisation United States English summary An English language summary is available. Address for correspondence AHRQ, Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA Email: AHRQTAP@ahrq.hhs.gov AccessionNumber 32013000237 Date abstract record published 17/04/2013 |
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