Abstract
BackgroundThe prognostic importance of anemia for cardiovascular (CV) events and mortality has been extensively investigated. However, little is known about the impact of transferrin saturation (TSAT), a marker reflecting the availability of iron for erythropoiesis, on clinical outcome in dialysis patients.MethodsA total of 879 anemic incident dialysis patients were recruited from the Clinical Research Center for End-Stage Renal Disease in Korea and were divided into 3 groups according to baseline TSAT of ≤20%, 20–40%, and >40%.ResultsThere were no differences in hemoglobin levels and the proportion of patients on erythropoiesis-stimulating agents or iron supplements among the 3 groups. During a mean follow-up duration of 19.3 months, 51 (5.8%) patients died. CV composite (11.71 vs. 5.55 events/100 patient-years, P = 0.001) and all-cause mortality rates (5.38 vs. 2.31 events/100 patient-years, P = 0.016) were significantly higher in patients with TSAT ≤20% compared to those with TSAT 20–40% (reference group). Cox regression analysis revealed that patients with TSAT ≤20% had 1.62- and 2.19-fold higher risks for CV composite outcome (P = 0.046) and all-cause mortality (P = 0.030). Moreover, TSAT ≤20% was significantly associated with left ventricular hypertrophy [odds ratio (OR) = 1.46], high-sensitivity C-reactive protein ≥3 mg/dL (OR = 2.09), N-terminal pro B-type natriuretic peptide ≥10000 pg/mL (OR = 2.04), and troponin-T≥0.1 ng/mL (OR = 2.02), on logistic regression analysis.ConclusionsLow TSAT was a significant independent risk factor for adverse clinical outcome in incident dialysis patients with anemia, which may be partly attributed to cardiac dysfunction and inflammation.
Highlights
Anemia is prevalent in patients with chronic kidney disease (CKD), and develops during the early stages of the disease and worsens as renal function declines [1,2]
While serum iron concentrations and transferrin saturation (TSAT) reflect the amount of iron available for erythropoiesis, serum ferritin levels are the only marker of total body iron stores
We investigated whether low TSAT was a significant predictor of CV mortality/composite outcome and all-cause mortality in Korean incident dialysis patients from the Clinical Research Center (CRC) for end-stage renal disease (ESRD)
Summary
Anemia is prevalent in patients with chronic kidney disease (CKD), and develops during the early stages of the disease and worsens as renal function declines [1,2]. Anemia in CKD patients is attributed to inadequate production of erythropoietin, iron and/or folate deficiency, secondary hyperparathyroidism, chronic inflammation, and bone marrow suppression due to uremic toxins [8]. Among these factors except for erythropoietin deficiency, iron deficiency is the leading cause of anemia in patients with CKD. Ferritin levels are greatly influenced by nutritional and/or inflammatory status and do not correlate well with bone marrow findings in patients with various chronic diseases [11] Considering these findings, TSAT ,20% and serum ferritin concentrations ,100 ng/mL are regarded as absolute iron deficiency, and TSAT ,20% and serum ferritin levels .100 ng/mL as relative iron deficiency [9,11]. Little is known about the impact of transferrin saturation (TSAT), a marker reflecting the availability of iron for erythropoiesis, on clinical outcome in dialysis patients
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