Research Article Assessing the Association between Serum Ferritin, Transferrin Saturation, and C-Reactive Protein in Northern Territory Indigenous Australian Patients with High Serum Ferritin on Maintenance Haemodialysis Sandawana William Majoni, 1,2,3 Paul D. Lawton, 3 Federica Barzi, 3 Alan Cass, 3 and Jaquelyne T. Hughes 1,3 1 Royal Darwin Hospital, Department of Nephrology, Division of Medicine, Tiwi, Darwin, NT, Australia 2 Northern Territory Medical Programme, Flinders University School of Medicine, Tiwi, Darwin, NT, Australia 3 Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia Correspondence should be addressed to Sandawana William Majoni; sandawanaw@aol.com Received 8 October 2016; Revised 29 December 2016; Accepted 9 January 2017; Published 24 January 2017 Academic Editor: Jaime Uribarri Copyright © 2017 Sandawana William Majoni et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. To determine the signifcance of high serum ferritin observed in Indigenous Australian patients on maintenance haemodialysis in the Northern Territory, we assessed the relationship between ferritin and transferrin saturation (TSAT) as measures of iron status and ferritin and C-reactive protein (CRP) as markers of infammation. Methods. We performed a retrospective cohort analysis of data from adult patients (≥18 years) on maintenance haemodialysis (>3 months) from 2004 to 2011. Results. Tere were 1568 patients. Te mean age was 53.9 (11.9) years. 1244 (79.3%) were Indigenous. 44.2% ( = 693) were male. Indigenous patients were younger (mean age [52.3 (11.1) versus 57.4 (15.2),  < 0.001]) and had higher CRP [14.7 mg/l (7–35) versus 5.9mg/l (1.9–17.5),  < 0.001], higher median serum ferritin [1069 g/l (668–1522) versus 794.9 g/l (558.5–1252.0),  < 0.001], but similar transferrin saturation [26% (19–37) versus 28% (20–38),  = 0.516]. We observed a small positive correlation between ferritin and TSAT ( 2 = 0.11,  < 0.001), no correlation between ferritin and CRP ( 2 = 0.001,  < 0.001), and positive association between high serum ferritin and TSAT ( < 0.001), Indigenous ethnicity ( < 0.001), urea reduction ratio ( = 0.001), and gender ( < 0.001) afer adjustment in mixed regression analysis. Conclusion. Serum ferritin and TSAT may inadequately refect iron status in this population. Te high ferritin was poorly explained by infammation. 1. Introduction Te efective treatment of anaemia in patients on main- tenance haemodialysis (MHD) includes identifcation and correction of iron defciency [1], use of erythropoiesis stim- ulating agents (ESA) as necessary, and achieving dialysis adequacy. Interpretation of iron status from most guidelines on anaemia management in people on MHD has been mainly based on transferrin saturation [the ratio of serum iron to the total iron binding capacity (TIBC) as a percentage, TSAT] and serum ferritin. Other measures of iron status have also been examined and include percentage hypochromic red cells (PHRC), reticulocyte haemoglobin content, and soluble transferrin receptor [2–4]. Te accurate determination of iron status is critical in patients dependent on maintenance haemodialysis in order to avoid overtreatment resulting in iron overload and minimising continuing anaemia from undertreatment of iron defciency. Te combination of serum ferritin levels and TSAT are commonly used worldwide in Renal Anaemia Management guidelines [2, 5]. Low TSAT and low ferritin are indicative of iron defciency. However, recent published evidence suggests Hindawi International Journal of Nephrology Volume 2017, Article ID 5490963, 8 pages https://doi.org/10.1155/2017/5490963