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  • Publication # 13-RA007

More evidence is needed on biomarkers to detect iron deficiency anemia in CKD patients

Comparative Effectiveness Research

A new research review from AHRQ evaluates the evidence on the comparative effectiveness and accuracy of using different biomarkers to identify iron deficiency anemia. The review found that no single laboratory test looking at biomarkers of iron status is adequate to determine iron deficiency, and more evidence is needed to determine the comparative accuracy of various biomarker combinations for diagnosing iron deficiency. A low level of evidence suggested that two tests measuring newer biomarkers (hemoglobin content in reticulocytes [CHr] and percentage of hypochromic red blood cells) better predict responses to intravenous (IV) iron treatment than classical markers (e.g., transferrin saturation or ferritin) in patients with chronic kidney disease undergoing hemodialysis.

Some trials suggested that managing patients’ iron levels by testing CHr may reduce the number of tests and IV iron treatments required compared to the use of classic biomarkers to guide treatment. However, there is insufficient evidence about the potential harms associated with these tests. Overall, the strength of evidence supporting these conclusions is low, particularly related to children and non-hemodialysis patients, and there is considerable clinical uncertainty regarding the use of newer biomarkers in the assessment of iron status and management of iron deficiency in patients with stages 3–5 chronic kidney disease.   Chronic Kidney disease currently affects 26 million people and anemia is a common side effect of the disease, so it is important to continue to study the most effective way to identify iron deficiency. Download and read Biomarkers for Assessing and Managing Iron Deficiency Anemia in Late-Stage Chronic Kidney Disease. This and many other materials are available on AHRQ’s Effective Health Care Program Web site at

Page last reviewed April 2013
Internet Citation: More evidence is needed on biomarkers to detect iron deficiency anemia in CKD patients: Comparative Effectiveness Research. April 2013. Agency for Healthcare Research and Quality, Rockville, MD.


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