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Abstract: SA-PO817

Efficient Hemoglobin Maintenance Levels Are Achieved by Relatively Lower Levels of Serum Ferritin and Moderate Transferrin Saturation in Hemodialysis Patients

Session Information

Category: Dialysis

  • 605 Dialysis: Anemia and Iron Metabolism


  • Ogawa, Chie, Maeda Institute of Renal Research, Kawasaki, Japan
  • Tsuchiya, Ken, Tokyo Women's Medical University, Shinjuku-ku, Japan
  • Kanda, Fumiyoshi, Maeda Institute of Renal Research, Kawasaki, Japan
  • Maeda, Kunimi, Maeda Institute of Renal Research, Kawasaki, Japan

The optimal iron levels for patients on hemodialysis (HD) are currently unknown. However, excessive iron intake can lead to oxidative stress or impair the efficiency of its use. To identify the optimal iron content for patients on HD, we investigated the relationship between hemoglobin (Hb) level and iron status in patients on HD.


208 HD-outpatients treated with recombinant human erythropoietin (rHuEPO) were followed up from July 2006 to June 2007. The doses of rHuEPO and low-dose iron supplement were adjusted to maintain a Hb level of 10–11 g/dL, according to the Japanese guidelines. Hepcidin 25 (Hep 25) was measured at baseline measured using LC-MS/MS assay. Using the mean values for a 1-year period, the relationships among Hb, s-ft levels, and TSAT levels were investigated based on a receiver operating characteristic curve (ROC) and a logistic regression model. In addition, the correlations among s-ft, TSAT, and Hep25 levels were analyzed by Pearson product–moment correlation coefficient.


By ROC, the cutoff point of s-ft and TSAT levels with a Hb ≥10 g/dL showed <90 ng/mL and ≥20%. Upon logistic regression model analysis with a Hb ≥ 10 g/dL set as the endpoint, the odds ratios relative to a group with s-ft ≥ 90 ng/mL and TSAT < 20% revealed that the group with s-ft < 90 ng/mL and TSAT ≥ 20% had the highest ratio: 46.75 (95% CI: 10.89–200.70, p < 0.001). Hep 25 exhibited a strong positive correlation with s-ft [r = 0.78 (95% CI: 0.72–0.83, p < 0.001)] and a weak positive correlation with TSAT [r = 0.18 (95% CI: 0.04–0.31, p = 0.010)].


In this study, the iron status showing s-ft < 90 ng/mL and TSAT ≥ 20% was optimal in HD patients receiving rHuEPO for anemia therapy. This result indicates that the threshold values for the optimal iron status may be lower than those currently recommended in the guidelines for iron level management.