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Abstract: SA-OR074

The Relationship between Non-Transferrin Bound Iron (NTBI) and Iron Utilization for Erythropoiesis in Maintenance Hemodialysis Patients

Session Information

Category: Anemia and Iron Metabolism

  • 202 Anemia and Iron Metabolism: Clinical


  • Kuragano, Takahiro, Hyogo College of Mediicne, Nishinomiya, Japan
  • Nakanishi, Takeshi, Hyogo College of Mediicne, Nishinomiya, Japan

The relationship between non-transferrin bound iron (NTBI) derived oxidation stress and arteriosclerosis in maintenance hemodialysis (MHD) patients has been reported. In this study, we investigated the determinant of serum NTBI and the relationship between NTBI and iron utilization for erythropoiesis in MHD patients who did not receive the iron preparations.


Study design: multicenter cross-sectional study. We evaluated the blood levels of hemoglobin (Hb), β2-microglobulin (βMG), total cholesterol, triglyceride, iron, hepcidin, ferritin, total iron binding capacity (TIBC), NTBI, Interleukin(IL)-6, tumor necrosis factor (TNF)-α, and high sensitive (hs) CRP in 126 MHD patients who did not receive the iron preparations for the past three months. To evaluate the relationship between serum NITB and iron utilization for erythropoiesis, patients were divided into 4 groups according to Hb and ferritin levels (Hb<10 g/dL and ferritin<50 ng/mL, Hb<10 g/dL and ferritin≥50 ng/mL, Hb≥10 g/dL nad ferritin<50 ng/mL, and Hb>10 g/dL and ferritin≥50 ng/mL).


There was no significant difference in the NTBI levels in patients with or without diabetes and hepatitis C. Moreover, there was no significant correlation among NTBI, age, hemodialysis duration, and inflammation index (IL-6, TNF-α, hsCRP). In multivariate analysis, only serum ferritin was selected as a significant (β=0.69, p<0.0001) predictor of serum NTBI levels. Even after adjusting according to the dose of ESA, the serum NTBI of patients with Hb<10 g/dL and ferritin≥50 ng/mL (0.72± 0.5(µM Fe)) had significantly higher levels than other groups ((Hb<10 g/dL and ferritin<50 ng/mL:0.57±0.35 (µM Fe), Hb≥10 g/dL and ferritin<50 ng/mL: 0.58±0.28 (µM Fe), and Hb>10 g/dL and ferritin≥50 ng/mL:0.62±0.41 (µM Fe).


In this study, we revealed that serum NTBI levels in MHD patients were related to the iron storage and iron utilization for erythropoiesis. Although, repleted iron storage patients with anemia who suspected dysutilization of iron for erythropoiesis already showed significantly higher serum NTBI levels; iron administration to these patients might cause further higher NTBI levels related with arteriosclerosis of MHD patients.