PMID- 18721738
OWN - NLM
STAT- MEDLINE
DCOM- 20081217
LR  - 20191210
IS  - 1532-8503 (Electronic)
IS  - 1051-2276 (Linking)
VI  - 18
IP  - 5
DP  - 2008 Sep
TI  - Validation of a composite scoring scheme in the diagnosis of folate deficiency in 
      a pediatric and adolescent dialysis cohort.
PG  - 430-9
LID - 10.1053/j.jrn.2008.05.009 [doi]
AB  - BACKGROUND: Laboratory indices are often poorly diagnostic of folate deficiency 
      (FD). Compared with iron depletion in hemodialysis (HD) populations, the impact 
      of FD is less appreciated. The composite scoring of hematologic indices of FD may 
      facilitate a prompt and accurate diagnosis, and enhance operational research on 
      folic acid therapy. OBJECTIVE: Our objectives were to (1) validate composite 
      scores of folate diagnostic indices, and (2) determine the reliability index of 
      the diagnostic tool. METHODS: A cohort of 30 subjects, with a mean age of 16 (SD 
      +/- 3.2 years), on HD and erythropoietin (EPO) for a minimum of 3 months was 
      studied. After a baseline hematologic assessment, routine folates were 
      administered for 6 months. Composite FD scores (FDS) of baseline mean corpuscular 
      volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin 
      concentration (MCHC), random distribution width (RDW), and hemoglobin were 
      determined. Validation and reliability statistics were then analyzed, using the 
      quantitative change in red blood cell folate/plasma homocysteine, or EPO 
      requirement after 6 months of folate use, as diagnostic criteria. RESULTS: The 
      mean FDS for FD and non-FD subsets were 3.0 +/- 1.3 and 1.4 +/- 0.9, respectively 
      (analysis of variance; P = .0001). The correlation coefficient, r(2), between FD 
      total and FDS was 0.61 (P = .001), and the coefficient between 2 (weekly) values 
      of RDW, MCV, MCH, and MCHC was >0.84 (P = .0001). Scoring tools derived from the 
      first (P = .002) and second (P = .01) halves of the laboratory indices remained 
      discriminatory for the FD and non-FD groups. Baseline serum folate is poorly 
      specific for FD, whereas FD score >or=3 had sensitivity, specificity, and 
      positive and negative predictive values close to 90%. CONCLUSIONS: Composite 
      scoring of erythrocyte indices was predictive of the FD diagnosis, as defined by 
      the quantitative response of red blood cell folate, homocysteine, and EPO dose to 
      folate therapeutic intervention. The diagnostic items yielded a high reliability 
      coefficient. The FDS scheme is a potential tool for the diagnosis and 
      surveillance of FD, particularly in at-risk populations (e.g., dialysis 
      subjects).
FAU - Kaskel, Fredrick J
AU  - Kaskel FJ
AD  - Division of Pediatric Nephrology, Children's Hospital at Montefiore of Albert 
      Einstein College of Medicine, Bronx, New York, USA.
FAU - Bamgbola, Oluwatoyin F
AU  - Bamgbola OF
LA  - eng
PT  - Journal Article
PT  - Validation Study
PL  - United States
TA  - J Ren Nutr
JT  - Journal of renal nutrition : the official journal of the Council on Renal 
      Nutrition of the National Kidney Foundation
JID - 9112938
RN  - 0 (Hemoglobins)
RN  - 0 (Recombinant Proteins)
RN  - 0LVT1QZ0BA (Homocysteine)
RN  - 11096-26-7 (Erythropoietin)
RN  - 935E97BOY8 (Folic Acid)
RN  - E1UOL152H7 (Iron)
SB  - IM
MH  - Adolescent
MH  - Analysis of Variance
MH  - Cohort Studies
MH  - Diagnosis, Differential
MH  - Erythrocytes/chemistry
MH  - Erythropoietin/*therapeutic use
MH  - Female
MH  - Folic Acid/blood/*therapeutic use
MH  - Folic Acid Deficiency/blood/*diagnosis/drug therapy
MH  - Hemoglobins/analysis
MH  - Homocysteine/blood
MH  - Humans
MH  - Iron/*blood
MH  - Kidney Failure, Chronic/*blood/complications/therapy
MH  - Male
MH  - Predictive Value of Tests
MH  - Recombinant Proteins
MH  - Renal Dialysis/*adverse effects
MH  - Sensitivity and Specificity
EDAT- 2008/08/30 09:00
MHDA- 2008/12/18 09:00
CRDT- 2008/08/30 09:00
PHST- 2007/09/20 00:00 [received]
PHST- 2008/08/30 09:00 [pubmed]
PHST- 2008/12/18 09:00 [medline]
PHST- 2008/08/30 09:00 [entrez]
AID - S1051-2276(08)00331-2 [pii]
AID - 10.1053/j.jrn.2008.05.009 [doi]
PST - ppublish
SO  - J Ren Nutr. 2008 Sep;18(5):430-9. doi: 10.1053/j.jrn.2008.05.009.