RESEARCH ARTICLE: Is Transferrin Saturation a Useful Marker of Iron Metabolism in Patients with Chronic Kidney Disease Treated with Hemodialysis?

Author: Ewa Kwiatkowska

Journal: The Open Urology & Nephrology Journal



According to the currently applicable KDIGO-2012 and ERBP 2013 guidelines, iron metabolism assessments for patients with Chronic Kidney Disease (CKD) are performed using such parameters as ferritin concentration and Transferrin Saturation (TSAT). Their values are to be treated as a basis on which to decide on providing iron substitution. Patients with Stage 5 CKD on maintenance hemodialysis commonly suffer from malnutrition syndrome and inflammation. One of the markers for malnutrition and inflammation is low transferrin concentration. Our study focused on establishing what percentage of patients this applied to and whether or not the transferrin saturation figure was artificially inflated in such cases.

Materials and Methods:

The study group included 66 patients with Stage 5 CKD on maintenance hemodialysis. Such data were analyzed as complete blood count, iron and ferritin concentrations, and Transferrin Saturation (TSAT). Other parameters – age, sex, time from their first hemodialysis, and the quality of their dialysis in the last six months – the Kt/V average.


It was found that only 12% of the study group patients had their transferrin concentrations above the lower limit of normal. The TSAT value correlated negatively with transferrin concentration. Transferrin concentration correlated negatively with time from first hemodialysis or ferritin concentration, and positively with body weight. Normal transferrin concentration was only seen in patients with ferritin concentrations of up to 400 μg/L. The group was divided according to transferrin concentration of <1.5 g/L or >1.5 g/L. These groups differed significantly in ferritin concentration and transferrin saturation. (p = 0.0005 and p = 0.004, respectively). The 1.5 g/L transferrin concentration point divides patients with mild and medium malnutrition. It is also the minimum transferrin content necessary to achieve hemoglobin values ≥10 g/dL determined using the ROC curve.


Low transferrin concentrations cause abnormally high TSAT values. In most patients on maintenance hemodialysis, this marker is not useful for assessing the availability of iron for erythropoiesis.

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RESEARCH ARTICLE: Management and Comorbidities in Middle-European Patients with Rheumatoid Arthritis: A Retrospective, Cross-sectional Comparison with COMORA Data

Author: Michael Schirmer

Journal: The Open Rheumatology Journal



To assess disease-specific characteristics and comorbidities in consecutive Middle-European Rheumatoid Arthritis (RA) patients, and to compare results with international data.


Cross-sectional retrospective analysis of consecutive RA patients from a Middle-European outpatient service. Data are compared to those of the international “Co-morbidity in Rheumatoid Arthritis” (COMORA) cohort.


80 RA patients with mean disease duration of 10.6 ± 8.3 years were enrolled within 5 months. Age was 62 ± 13 years and 75% were female. The Middle-European cohort showed slightly lower disease activity than the Austrian COMORA subcohort. 88.8% of all Middle-European RA patients were in remission or had low disease activity. Despite comparable disease characteristics, the percentage of patients ever treated with biological disease-modifying antirheumatic drugs (bDMARDs) was lower in the middle-European cohort (36.3%) than in the Austrian subcohort of COMORA (59%), but similar to the international COMORA cohort (39%). More smokers were in the Austrian COMORA subcohort (48.0) than in the Middle-European (22.5%) and the COMORA cohort (13%). Hypertension (38.8%) and osteoporosis (30.0%) were the most frequent comorbidities.


Comparison of RA patients from this Middle-European cohort with the Austrian COMORA subcohort showed less frequent use of bDMARDs during disease course – probably according to the local referral structure. 88.8% of the Middle-European RA-patients achieved the treat-to target-aim of remission or low disease activity.

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CASE REPORT: Estimation of Infectious Medical Waste Quantities on a Per-patient Basis: An Observational Study at a Hospital

Author: Yukihiro Ikeda

Journal: The Open Waste Management Journal



Infectious medical waste management in hospitals is very important. The potential impacts of infectious medical waste discharged from hospitals on populations and society are considered greater than those of general industrial waste. Therefore, the estimation of infectious medical waste discharged from healthcare facilities should be accurate. The present study reports the quantity of infectious medical waste discharged per ward per day per inpatient by weight.


In medical wards, the digestive surgery ward discharged the most infectious medical waste. In addition, the digestive surgery ward had the highest quantity of infectious medical waste per day per inpatient. Infectious medical waste quantity estimates based on beds were lower than those based on inpatients, with minimum and maximum underestimates of 6% and 21%, respectively.

Results & Discussion:

Infectious medical waste discharged per patient per day was low in the outpatient department. The operating room and the emergency department discharged 10-fold more infectious medical waste than the wards. The operating room, the emergency department, and the clinical inspection department accounted for 60% of infectious medical waste discharged from hospitals.


Notably, there are considerable differences among departments when evaluating hospital waste, particularly in hospitals with surgery and critical care departments, which is different in the case of evaluations based on bed counts.

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