Author(s)

Saeko Kumon^1,2, Yoichiro Tanaka^1,2, Kazuo Kimura^1,2, Takako Onuki^1,2, Shigeru Otsubo^1,3, Kosaku Nitta¹

¹Department of Medicine, Towa Hospital, Tokyo, Japan.
²Department of Medicine, Kidney Center, Tokyo Women’s Medical University, Tokyo, Japan.
³Department of Blood Purification, Sangenjaya Hospital, Tokyo, Japan.

Background: The relationship between the iron indices and mortality in maintenance hemodialysis (MHD) patients has remained unclear. We performed a retrospective, observational cohort study to investigate the relationships between serum ferritin levels and mortality in MHD patients. Methods: MHD outpatients (n = 150) were followed up for a median period of 49 months. Their ESA and low-dose iron supplement dosages were adjusted to maintain their hemoglobin (Hb) concentrations in the 10 - 11 g/dl range in accordance with Japanese guidelines. The Kaplan-Meier method, log-rank tests, and Cox proportional hazards models were used to perform the statistical analyses. The patients were divided into 3 groups according to their serum ferritin levels: a serum ferritin < 50 ng/ml group; a 50 - 100 ng/ml group; and a > 100 ng/ml group. Results: During the median follow-up period of 49 months, there were 55 deaths. The multivariate analysis showed no significant associations between the ferritin level groups and all-cause mortality or cardiovascular (CV) events, and the Kaplan-Meier analysis showed no significant differences among the 3 ferritin level groups in all-cause mortality and CV event rates. However, the multivariate analysis revealed that age, CRP level and a history of previous CV disease were independently associated with all-cause mortality, while diabetes, previous CV disease, and iron administration were independently associated with CV events. Conclusion: The results of this study revealed no significant associations of MHD patients between the ferritin ranges and all-cause mortality or CV events. Thus, the adverse clinical outcomes in these patients were independently associated with other markers and not with their serum ferritin levels.

Anemia, Ferritin, Hemodialysis, Mortality

Kumon, S. , Tanaka, Y. , Kimura, K. , Onuki, T. , Otsubo, S. and Nitta, K. (2018) Iron Indices and Mortality in Maintenance Hemodialysis Patients. International Journal of Clinical Medicine, 9, 454-466. doi: 10.4236/ijcm.2018.95039.