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Abstract: TH-PO269

C-Reactive Protein Levels Might Affect the Association of Ferritin and Survival in Hemodialysis Patients

Session Information

Category: Anemia and Iron Metabolism

  • 202 Anemia and Iron Metabolism: Clinical


  • Suzuki, Shunji, Tokyo Woman Medical University, Shinjuku-ku, Tokyo, Japan
  • Hanafusa, Norio, Tokyo Women's Medical University, Shinjuku-ku, TOKYO, Japan
  • Kawaguchi, Hiroshi, Tokiwa-kai Medical Corporation, Iwaki, Japan
  • Tsuchiya, Ken, Tokyo Women's Medical University, Shinjuku-ku, TOKYO, Japan
  • Nitta, Kosaku, Tokyo Women's Medical University, Shinjuku-ku, TOKYO, Japan

Ferritin is associated with survival in hemodialysis (HD) patients; higher ferritin levels are associated with worse survival. Inflammatory status is also associated with worse survival in the same population. Serum ferritin itself increases in the presence of inflammation. Therefore, we hypothesized that inflammation affects the association between ferritin and survival.
We investigated the interaction of C-reactive protein (CRP) and ferritin for dialysis patient survival.


All patients who were receiving hemodialysis HD treatment thrice a week at Jyoban Hospital, Fukushima, Japan were included in the study. The study period was set as July 2012 through August 2014. Baseline laboratory data including CRP, ferritin, and other clinical indices were collected in July 2012. CRP and ferritin were dichotomized in the subsequent analysis. The study outcome was set as all-cause mortality. Analyses were conducted using Cox’s proportional hazard models. Interaction between CRP and ferritin was also included in the study. Analyses stratified by CRP levels were also conducted.


This study examined 397 patients, 258 of whom were male; 44.6% were diabetic. Their average age was 70.6 years, with an average of 3.6 years using on HDhemodialysis. During the observation period, 73 patients died. Examination of the entire population demonstrated that high CRP (>0.2 mg/dl), but not high ferritin (>200 ng/ml), is associated with worse survival: HR 3.31 (95%CI 1.35–14.5) and HR 0.64 (95%CI 0.15–1.54), respectively. Interaction of CRP and ferritin was also significant. Stratified analysis demonstrated that high ferritin was associated with better survival (HR 0.17, 95%CI 0.01–0.81) only in the low-CRP stratum, but not (HR 2.24, 95%CI 0.94–4.77) in the high-CRP stratum.


Results demonstrated that inflammation status might affect the association between ferritin and survival in hemodialysis HD patients. Iron dosing might be individualized in light of inflammation results.