PLACE DU RECEPTEUR SOLUBLE DE LA TRANSFERRINE DANS LE DIAGNOSTIC ET LE TRAITEMENT DE LA CARENCE MARTIALE CHEZ L’INSUFFISANT RENAL CHRONIQUE

Abstract

Introduction: Iron deficiency is the most common nutritional deficiency and the most common cause of anemia worldwide. The diagnosis is more or less complex depending on the context and its prevalence is not easy to measure. A part from an inflammatory situation, the diagnosis of certitude is based on low serum ferritin below 15 ug / L regardless of sex. As part of anemia associated with chronic diseases, it is often underestimated as difficult to diagnose because ferritin is a protein of inflammation and of which the synthesis increases in this context. Objectives: - To describe the parameters of the dosage of soluble transferrin receptor. - To determine the iron status of two categories of chronic renal failure patients undergoing hemodialysis or peritoneal dialysis. - To evaluate the response of treatment with EPO and establish the predictive role of soluble transferrin receptor in the therapeutic response. Subjects and methods: For this prospective study 145 patients were retained in chronic renal terminal failure undergoing hemodialysis or peritoneal dialysis from the wilaya of Tlemcen . These patients are recruited from differents hemodialysis centers: A university hospital centre, in this case, the renal-dialysis CHU DR TIDJANI DAMERDJI and 3 private clinics in the wilaya of Tlemcen. The study began in March 2007 with a follow-up of 30 months. To answer at all the objectives, three categories of subjects were separated: - The first class of patients according to the method of an extra-renal purification. - The second corresponds to patients treated with EPO and accessorily with iron. - The third class considered as the reference population corresponding to blood donors. The statistical analysis was performed using Epi Info 6.04 and SPSS. Results: Our results showed that the sTfR is a diagnosis test which has a sensitivity and specificity of the respective average efficiency of 65% and 54.5%.The ROC curve analysis of sTfR reached a fairly high optimal threshold (cut off: 9.3 mg / l), which is twice the value found in our reference population. The absolute or functional iron deficiency is present in 37.6%. It is consistent with most studies, however, the functional deficit remains underestimated. The predictive role of sTfR in the therapeutic response to EPO evaluate sTfR increasing more than 30% after 1month and its comparison with the basal rate is not proved in our serie. Conclusion: Our study has confirmed that sTfR has a mean efficacy diagnosis. It remains surely insufficient for the diagnosis of functional iron deficiency in chronic renal failure. It is the same that its ability to predict therapeutic response to EPO. Key words: Iron deficiency, Iron deficiency anemia, soluble transferrin receptor, hemodialysis., chronic renal failure, ferritin