The Different Association Between Serum Ferritin and Mortality in Hemodialysis and Peritoneal Dialysis Patients Using Japanese Nationwide Dialysis Registry

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2015 Nov 25

PMID 26599216

Citations 13

Authors

Yukio Maruyama

Keitaro Yokoyama

Takashi Yokoo

Takashi Shigematsu

Kunitoshi Iseki

Yoshiharu Tsubakihara

Affiliations

Soon will be listed here.

Abstract

Background/aims: Monitoring of serum ferritin levels is widely recommended in the management of anemia among patients on dialysis. However, associations between serum ferritin and mortality are unclear and there have been no investigations among patients undergoing peritoneal dialysis (PD).

Methods: Baseline data of 191,902 patients on dialysis (age, 65 ± 13 years; male, 61.1%; median dialysis duration, 62 months) were extracted from a nationwide dialysis registry in Japan at the end of 2007. Outcomes, such as one-year mortality, were then evaluated using the registry at the end of 2008.

Results: Within one year, a total of 15,284 (8.0%) patients had died, including 6,210 (3.2%) cardiovascular and 2,707 (1.4%) infection-related causes. Higher baseline serum ferritin levels were associated with higher mortality rates among patients undergoing hemodialysis (HD). In contrast, there were no clear associations between serum ferritin levels and mortality among PD patients. Multivariate Cox regression analysis of HD patients showed that those in the highest serum ferritin decile group had higher rates of all-cause and cardiovascular mortality than those in the lowest decile group (hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.31-1.81 and HR, 1.44; 95% CI, 1.13-1.84, respectively), whereas associations with infection-related mortality became non-significant (HR, 1.14; 95% CI, 0.79-1.65).

Conclusions: Using Japanese nationwide dialysis registry, higher serum ferritin values were associated with mortality not in PD patients but in HD patients.

Citing Articles

Association of Estimated Total Body Iron with All-Cause Mortality in Japanese Hemodialysis Patients: The Miyazaki Dialysis Cohort Study.

Toida T, Sato Y, Komatsu H, Fujimoto S Nutrients. 2023; 15(21).

PMID: 37960311 PMC: 10649821. DOI: 10.3390/nu15214658.

Iron status and anemia control are related to peritoneal membrane properties in peritoneally dialyzed patients.

Glogowski T, Wojtaszek E, Malyszko J Front Med (Lausanne). 2023; 10:1148094.

PMID: 37484854 PMC: 10359623. DOI: 10.3389/fmed.2023.1148094.

Elevated Ferritin Levels Associated with High Body Fat Mass Affect Mortality in Peritoneal Dialysis Patients.

Lee H, Noh H, An J, Song Y, Kim S, Kim J Nutrients. 2023; 15(9).

PMID: 37432308 PMC: 10180848. DOI: 10.3390/nu15092149.

The Prognostic Performance of Ferritin in Patients with Acute Myocardial Infarction: A Systematic Review.

Brinza C, Floria M, Popa I, Burlacu A Diagnostics (Basel). 2022; 12(2).

PMID: 35204567 PMC: 8870888. DOI: 10.3390/diagnostics12020476.

Association of anemia and iron parameters with mortality among prevalent peritoneal dialysis patients in Taiwan: the AIM-PD study.

Kuo K, Liu J, Lin M, Hsu C, Tarng D Sci Rep. 2022; 12(1):1269.

PMID: 35075212 PMC: 8786856. DOI: 10.1038/s41598-022-05200-3.

References

Langston R, Presley R, Flanders W, McClellan W . Renal insufficiency and anemia are independent risk factors for death among patients with acute myocardial infarction. Kidney Int. 2003; 64(4):1398-405. DOI: 10.1046/j.1523-1755.2003.00200.x. View

Locatelli F, Aljama P, Barany P, Canaud B, Carrera F, Eckardt K . Revised European best practice guidelines for the management of anaemia in patients with chronic renal failure. Nephrol Dial Transplant. 2004; 19 Suppl 2:ii1-47. DOI: 10.1093/ndt/gfh1032. View

Cuevas X, Garcia F, Martin-Malo A, Fort J, Llados F, Lozano J . Risk factors associated with cardiovascular morbidity and mortality in Spanish incident hemodialysis patients: two-year results from the ANSWER study. Blood Purif. 2011; 33(1-3):21-9. DOI: 10.1159/000332395. View

Kalantar-Zadeh K, Regidor D, McAllister C, Michael B, Warnock D . Time-dependent associations between iron and mortality in hemodialysis patients. J Am Soc Nephrol. 2005; 16(10):3070-80. DOI: 10.1681/ASN.2005040423. View

McFarlane P, Pisoni R, Eichleay M, Wald R, Port F, Mendelssohn D . International trends in erythropoietin use and hemoglobin levels in hemodialysis patients. Kidney Int. 2010; 78(2):215-23. DOI: 10.1038/ki.2010.108. View

Galic G, Tomic M, Galesic K, Kvesic A, Soljic M, Londar Z . The etiological relation between serum iron level and infection incidence in hemodialysis uremic patients. Coll Antropol. 2011; 35(1):93-101. View

Wetmore J, Peng Y, Monda K, Kats A, Kim D, Bradbury B . Trends in anemia management practices in patients receiving hemodialysis and peritoneal dialysis: a retrospective cohort analysis. Am J Nephrol. 2015; 41(4-5):354-61. DOI: 10.1159/000431335. View

Coronel F, Herrero J, Montenegro J, Fernandez C, Gandara A, Conesa J . Erythropoietin requirements: a comparative multicenter study between peritoneal dialysis and hemodialysis. J Nephrol. 2004; 16(5):697-702. View

Coyne D . Hepcidin: clinical utility as a diagnostic tool and therapeutic target. Kidney Int. 2011; 80(3):240-4. DOI: 10.1038/ki.2011.141. View

10.

Litton E, Xiao J, Ho K . Safety and efficacy of intravenous iron therapy in reducing requirement for allogeneic blood transfusion: systematic review and meta-analysis of randomised clinical trials. BMJ. 2013; 347:f4822. PMC: 3805480. DOI: 10.1136/bmj.f4822. View

11.

Besarab A, Bolton W, Browne J, Egrie J, Nissenson A, Okamoto D . The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin. N Engl J Med. 1998; 339(9):584-90. DOI: 10.1056/NEJM199808273390903. View

12.

Tsubakihara Y, Nishi S, Akiba T, Hirakata H, Iseki K, Kubota M . 2008 Japanese Society for Dialysis Therapy: guidelines for renal anemia in chronic kidney disease. Ther Apher Dial. 2010; 14(3):240-75. DOI: 10.1111/j.1744-9987.2010.00836.x. View

13.

. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease. Am J Kidney Dis. 2006; 47(5 Suppl 3):S11-145. DOI: 10.1053/j.ajkd.2006.03.010. View

14.

Ishida J, Johansen K . Iron and infection in hemodialysis patients. Semin Dial. 2013; 27(1):26-36. PMC: 4016233. DOI: 10.1111/sdi.12168. View

15.

Ichii H, Masuda Y, Hassanzadeh T, Saffarian M, Gollapudi S, Vaziri N . Iron sucrose impairs phagocytic function and promotes apoptosis in polymorphonuclear leukocytes. Am J Nephrol. 2012; 36(1):50-7. PMC: 3986045. DOI: 10.1159/000339285. View

16.

Pollak V, Lorch J, Shukla R, Satwah S . The importance of iron in long-term survival of maintenance hemodialysis patients treated with epoetin-alfa and intravenous iron: analysis of 9.5 years of prospectively collected data. BMC Nephrol. 2009; 10:6. PMC: 2671502. DOI: 10.1186/1471-2369-10-6. View

17.

Molnar M, Mehrotra R, Duong U, Kovesdy C, Kalantar-Zadeh K . Association of hemoglobin and survival in peritoneal dialysis patients. Clin J Am Soc Nephrol. 2011; 6(8):1973-81. PMC: 3359540. DOI: 10.2215/CJN.01050211. View

18.

Pisoni R, Bragg-Gresham J, Young E, Akizawa T, Asano Y, Locatelli F . Anemia management and outcomes from 12 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2004; 44(1):94-111. DOI: 10.1053/j.ajkd.2004.03.023. View

19.

Akizawa T, Saito A, Gejyo F, Suzuki M, Nishizawa Y, Tomino Y . Low hemoglobin levels and hypo-responsiveness to erythropoiesis-stimulating agent associated with poor survival in incident Japanese hemodialysis patients. Ther Apher Dial. 2014; 18(5):404-13. DOI: 10.1111/1744-9987.12155. View

20.

Hasuike Y, Nonoguchi H, Tokuyama M, Ohue M, Nagai T, Yahiro M . Serum ferritin predicts prognosis in hemodialysis patients: the Nishinomiya study. Clin Exp Nephrol. 2010; 14(4):349-55. DOI: 10.1007/s10157-010-0288-x. View