Kidney Week

Abstract: FR-PO401

Increased Mortality Risk Is Associated with Abnormal Iron Status in Japanese Patients on Hemodialysis: A Nationwide Cohort Study

Session Information

• Hemodialysis Epidemiology and Outcomes
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Nishiwaki, Hiroki, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan

Hiroki Nishiwaki, MD, PhD, MPH

• Imaizumi, Takahiro, Nagoya University, Nagoya, Aichi, Japan

Takahiro Imaizumi, MD, PhD

• Hasegawa, Takeshi, Showa University, Yokohama, Kanagawa, Japan

Takeshi Hasegawa, MD, PhD, MPH

• Kosugi, Takaaki, Nara Medical University, Kashihara, Nara, Japan

Takaaki Kosugi, MD, PhD

• Maruyama, Yukio, Jikei University School of Medicine, Minato, Tokyo, Japan

Yukio Maruyama, MD

• Tsuruya, Kazuhiko, Nara Medical University, Kashihara, Nara, Japan

Kazuhiko Tsuruya, MD, PhD

• Ito, Yasuhiko, Aichi Medical University, Nagakute, Aichi, Japan

Yasuhiko Ito, MD, PhD

• Honda, Hirokazu, Showa University, Yokohama, Kanagawa, Japan

Hirokazu Honda, MD, PhD

• Kuragano, Takahiro, Hyogo Medical University, Nishinomiya, Hyogo, Japan

Takahiro Kuragano, PhD

Background

There have been numerous studies on the characteristics of iron parameters in patients with end-stage kidney disease undergoing hemodialysis (HD), yet it remains unclear whether the interrelationships among these indicators are associated with increased mortality. We investigated the association between the interrelationships of these parameters and 1-year mortality.

Methods

The data utilized in this study were acquired from the Japanese Renal Data Registry (JRDR) database spanning the years 2019 to 2020. This study included patients who were alive and undergoing HD or hemofiltration three times a week without concurrent peritoneal dialysis therapy at the end of 2019. The exposures of interest were ferritin, transferrin saturation (TSAT), iron (Fe), and total iron binding capacity (TIBC). The outcome measure for this study was one-year all-cause mortality. The association between the combination of ferritin and TSAT, and the combination of TIBC and Fe, with mortality at one year was evaluated using contour plots of multivariate Cox proportional hazards models adjusted for the following variables including demographics, cardiovascular disease, laboratory data including C-reactive protein, and medications.

Results

The contour plot for the combination of ferritin and TSAT (Fig1) showed that the hazard ratio (HR) for mortality did not change significantly regardless of the ferritin value in the low TSAT group, but in the high TSAT group, higher ferritin was associated with death; in the combination of Fe and TIBC (Fig2), the HR for mortality was higher in the low Fe group at higher values of TIBC. This relationship disappeared when Fe was above the reference level.

Conclusion

The combination of ferritin and TSAT has been used in a similar approach in pre-dialysis CKD patients in previous studies (Cho 2019 and Guedes 2021), but the results are very different. The reasons for this difference lie in the disparity in populations and the addition of inflammatory markers as adjustment factors.