Kidney Week

Abstract: TH-OR66

Iron Deficiency Increases Mortality Risk among Incident Peritoneal Dialysis Patients

Session Information

• Home Dialysis Hodgepodge: Novel Mechanisms, Solutions, Technologies, and Ideas
  October 24, 2024 | Location: Room 8, Convention Center
  Abstract Time: 04:50 PM - 05:00 PM

Category: Dialysis

• 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

• Rigodon, Vladimir, Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil

Vladimir Rigodon

• Hartley, Brianna, Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil

Brianna Hartley

• Pecoits, Peter G., Indiana University, Bloomington, Indiana, United States

Peter G. Pecoits

• Larkin, John W., Fresenius Medical Care, Waltham, Massachusetts, United States

John W. Larkin, PhD

• Jiao, Yue, Fresenius Medical Care, Waltham, Massachusetts, United States

Yue Jiao, PhD

• Neri, Luca, Fresenius Medical Care, Crema, Italy

Luca Neri, MD, PhD

• Usvyat, Len A., Fresenius Medical Care, Waltham, Massachusetts, United States

Len A. Usvyat, PhD

• Chatoth, Dinesh K., Fresenius Medical Care, Waltham, Massachusetts, United States

Dinesh K. Chatoth, MD, FASN

• Hymes, Jeffrey L., Fresenius Medical Care, Waltham, Massachusetts, United States

Jeffrey L. Hymes, MD

• Maddux, Franklin W., Fresenius Medical Care AG, Bad Homburg, Hessen, Germany

Franklin W. Maddux, MD

• Kooman, Jeroen, Maastricht University Medical Center, Maastricht, Netherlands

Jeroen Kooman, MD, PhD

• Moraes, Thyago Proença de, Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil

Thyago Proença de Moraes, MD, PhD

• Barretti, Pasqual, Universidade Estadual Paulista, São Paulo, Brazil

Pasqual Barretti, MD, PhD

• Kotanko, Peter, Renal Research Institute, New York, New York, United States

Peter Kotanko, MD, FASN

• Pecoits-Filho, Roberto, Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil

Roberto Pecoits-Filho, MD, PhD, FASN

• Guedes, Murilo Henrique, Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil

Murilo Henrique Guedes, MD, PhD

Background

Iron deficiency (ID) can be more common in peritoneal dialysis (PD) vs hemodialysis. Administration of IV iron can be more challenging in PD and may influence iron repletion. Outcomes related to ID in PD are undefined. We investigate mortality risk associated with transferrin saturation (TSAT) and ferritin levels among patients starting PD in a national dialysis network.

Methods

We evaluated data on adults (age ≥18 years) who started PD at a US dialysis network (Fresenius Medical Care, Waltham, MA) between December 2004 and January 2011. Patients were required to be on PD for ≥180 days, and have ≥1 value for TSAT, ferritin and hemoglobin (Hgb). We considered categories for TSAT (≤20%, >20-≤30% reference, >30-≤40%, >40-≤50% and >50%). Cox proportional hazards model assessed mortality risk with stepwise adjustment across 6 models.

Results

Of 11,261 patients, majority were male (54.4%), Caucasian (70.4%) and mean age of 55.2 years. Mean Hgb, TSAT and ferritin values at baseline (≤180 days after PD start) were 12.1 g/dL, 31% and 443.6 ng/ml, respectively. ID (TSAT ≤20%) was present in 10.4% of patients. TSAT ≤20% was found to associate with higher mortality risk across all models (fully adjusted model hazard ratio (HR)=1.30, 95% confidence interval (CI)=1.09, 1.55) (Figure 1). TSAT levels >20% were not associated with mortality risk.

Conclusion

We observed about 10% of patients starting PD have ID as seen by TSAT ≤20% during the first 6 months of therapy. ID in incident PD was found to associate with a 30% increased mortality risk. These findings expand upon the emerging science on ID risks in non-dialysis dependent kidney disease (Guedes M et al., JASN 2021), and highlight the importance of evaluating ID in PD, regardless of Hgb status.

Funding

• Commercial Support – Fresenius Medical Care, Pontifícia Universidade Católica do Paraná, Baxter Healthcare