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Anemia of end-stage renal disease can be managed relatively successfully by recombinant human erythropoietin (EPO). Serum ferritin concentration and iron saturation ratio are among the two most commonly used markers of iron status in maintenance dialysis patients.1 According to National Kidney Foundation (NKF) kidney disease and dialysis outcome quality initiative (K/DOQI) guidelines, the iron administration should be withheld for a serum ferritin level > 800 ng/mL in these patients, since such high ferritin levels may reflect iron overload.2 However, serum ferritin is also an acute phase reactant and can be increased in inflammation.3-5 Inflammation is quite common in maintenance dialysis patients, and its prevalence among maintenance hemodialysis (MHD) patients may be as high as 40 to 60%. Hence, it is quite possible that high levels of serum ferritin are engendered by inflammation independently of iron stores.6 However, it is not clear whether serum ferritin is indeed significantly increased in inflammation at different levels of body iron in dialysis patients. Moreover, inflammation is closely related to protein-energy malnutrition in dialysis patients, and the simultaneous combination of these two conditions, also referred to as ‘malnutritioninflammation complex syndrome’ (MICS), is observed frequently in dialysis patients.6 Over past 15 years, there has been an exponential growth of knowledge in inflammation in CKD and end stage renal disease (ESRD), which laid to evaluation in our perception of inflammation as a novel risk factor for morbidity and mortality associated with CKD.7 Although the emergence of erythropoietin stimulating agents has a revolution the anemia management of CKD,8 strategies to assess iron status have remained indistinct. Ferritin though a reliable marker of body irons status,9 is also known to be influenced by non-iron related conditions 1Professor and Head, 2Tutor, 3Professor 1Department of Biochemistry, Bharati Vidyapeeth Medical College, Pune, Maharashtra, India 2,3Department of Biochemistry, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India

Serum Ferritin Levels in Patients of Chronic Kidney Disease on Hemodialysis: A Need to Redefine Cutoff for Iron/Erythropoietin Therapy