Essentials

David Charytan and other members of the Dialysis Advisory Group of the American Society of Nephrology have written a highly pertinent and timely review on the need for a robust evidence base for clinical practice in nephrology. In contrast to cardiology (and indeed most other hospital specialties!), nephrology lags behind, in terms of robust scientific evidence for much of its clinical practice, and this is the main focus of Charytan’s review.

Iron deficiency can have a significant, deleterious effect on quality of life in patients with specific types of cancer. Evidence suggests a correlation between iron deficiency and poor Eastern Cooperative Oncology Group (ECOG) performance status in patients with solid tumours; however no such correlation is observed in patients with haematological malignancies1.

Iron deficiency also correlates with significant impairment of physical, immunological and cognitive function, and fatigue, in patients with non-malignant tumours1,2.

Iron deficiency is a common disorder among patients with chronic kidney disease (CKD). A large-scale, epidemiological analysis conducted in 2009 suggests that the majority of patients with impaired kidney function (identified by reduced creatinine clearance) have low levels of iron, with approximately 58% of men and over 70% of women reaching the haematological definition of iron deficiency (See figure below)1. Rather than being a feature of later stages of disease only, iron deficiency has been reported from as early as CKD stage 31.

Commonalities in the typical symptoms of iron deficiency and heart failure mean clinical presentation is of low diagnostic value in these patients. A thorough screening of blood iron status – including measures of storage, circulating and functional iron – are required to accurately diagnose iron deficiency and should be routine practice in this patient population.

Table 2. The commonalities between symptoms of heart failure (HF) and iron deficiency (ID) and iron deficiency anaemia (IDA)1,2

Iron deficiency is a frequent complication associated with cancer. In a single-centre study of 1528 patients presenting sequentially between 1 October 2009 and 20 January 2010, more than 40% had iron deficiency, defined as a transferrin saturation (TSAT) level of <20% (see figure below)1.

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