{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:16:33Z","timestamp":1790662593938,"version":"4.1.0"},"reference-count":69,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2020,4,17]],"date-time":"2020-04-17T00:00:00Z","timestamp":1587081600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>After a brief review of physiological iron metabolism, we describe diagnostic tests for iron status and iron deficiency anemia in patients without chronic kidney disease (CKD) or inflammation. Thereafter we review the dysregulation of iron metabolism in CKD. Specific emphasis is placed on the role of the \u2018inflammatory\u2019 state that develops with the progression of CKD. It invokes changes in iron metabolism that are the exact opposite of those occurring during pure iron deficiency. As a result, transferrin saturation (TSAT) becomes a poorer index of iron availability to the bone marrow and serum ferritin no longer represents iron that can be used during erythropoiesis. We argue that serum iron may provide more information to guide iron therapy than TSAT. In other words, the emphasis on TSAT is misplaced. With the development of a number of hypoxia-inducible factor prolyl hydroxylase inhibitors, which restore iron metabolism toward the \u2018physiologic state\u2019, the iron indices indicating sufficient iron availability to avoid functional iron deficiency during therapy of CKD-associated anemia are likely to change. We summarize these changes in the section \u2018A peek into things to come!\u2019, citing the available data.<\/jats:p>","DOI":"10.1093\/ndt\/gfaa048","type":"journal-article","created":{"date-parts":[[2020,2,25]],"date-time":"2020-02-25T20:14:54Z","timestamp":1582661694000},"page":"1377-1383","source":"Crossref","is-referenced-by-count":23,"title":["The problem with transferrin saturation as an indicator of iron \u2018sufficiency\u2019 in chronic kidney disease"],"prefix":"10.1093","volume":"36","author":[{"given":"Anatole","family":"Besarab","sequence":"first","affiliation":[{"name":"Stanford University School of Medicine, Stanford University, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tilman B","family":"Drueke","sequence":"additional","affiliation":[{"name":"INSERM U1018, Team 5, CESP, Paris Saclay University, Paris-Sud Univ, UVSQ, Villejuif, 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