Abstract
BackgroundThis study aimed to ascertain whether the correlation of high serum ferritin with mortality is affected by systemic inflammation and to investigate the optimal serum ferritin level for predicting death when inflammation is considered in peritoneal dialysis (PD) patients.MethodsWe classified 221 patients into four groups according to serum ferritin concentration (100 μg/L) and high-sensitivity CRP (hs-CRP) level (3 mg/L), and followed them regularly from the date of catheterization to Dec 31, 2016, at Sun Yat-Sen Memorial Hospital, China. Clinical and biochemical data were collected at baseline, and clinical outcomes such as all-cause and cardiovascular mortality were assessed.ResultsDuring a median follow-up of 35 months (3 ~ 109 months), 50 (22.6%) deaths occurred. Cardiovascular disease (46.0%) was the most common cause of death, followed by infection (10.0%). The Kaplan–Meier survival analysis and log-rank test revealed significantly worse survival accumulation among PD patients with higher serum ferritin (≥100 μg/L) under elevated hsCRP levels (> 3 mg/L) (P = 0.022). A multivariate Cox regression analysis revealed that an increased serum ferritin level was independently associated with a higher risk of all-cause and cardiovascular mortality in PD patients (HR = 3.114, P = 0.021; and HR = 9.382, P = 0.032) with hsCRP above 3 mg/L after adjusting for relevant confounding factors.ConclusionHigher serum ferritin levels were associated with an increased risk of all-cause and cardiovascular mortality in patients undergoing PD only in the presence of elevated hsCRP levels. The correlation of serum ferritin with poor outcome should take into consideration systemic inflammation.
Highlights
This study aimed to ascertain whether the correlation of high serum ferritin with mortality is affected by systemic inflammation and to investigate the optimal serum ferritin level for predicting death when inflammation is considered in peritoneal dialysis (PD) patients
Comparison of the low and high ferritin groups at baseline The cutoff value of 100 μg/L was determined based on clinical practice recommendations (Kidney Disease Outcomes Quality Initiative [KDOQI] 2006 [13], Kidney Disease: Improving Global Outcomes [KDIGO] 2012 [14], and The Japanese Society for Dialysis Therapy (JSDT) guidelines [15, 16] and previous research [17]
Patients in the ferritin ≥100 μg/L and High-sensitivity C-reactive protein (hsCRP) > 3 mg/L group had a higher proportion of males and higher all-cause mortality (32.3%) and cardiovascular mortality (15.6%). These four groups showed no significant differences in age, body mass index (BMI), 24-h urine amount, blood pressure, Kt/V, peritoneal equilibration test (PET), blood urea nitrogen (BUN), serum creatinine, phosphorus, calcium, cholesterol, triglyceride, LDL-C, HDL-C, apolipoprotein A, uric acid, albumin, prealbumin, hemoglobin iron and transferrin saturation (TSAT)
Summary
This study aimed to ascertain whether the correlation of high serum ferritin with mortality is affected by systemic inflammation and to investigate the optimal serum ferritin level for predicting death when inflammation is considered in peritoneal dialysis (PD) patients. The effect of serum ferritin on the long-term outcome of PD patients remains unclear. Recent studies have shown that persistent inflammation exacerbates the effects of risk factors that predict the poor outcome of CKD patients, such as serum albumin and osteoprotegerin [11, 12]. We undertook this study to (1) ascertain the serum ferritin level that is negatively associated with the long-term survival of PD patients and (2) investigate whether the predictive role of serum ferritin is affected by hsCRP levels
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