Abstract: TH-PO268
Different Effects of Iron Indices on Mortality in Patients with Autosomal Dominant Polycystic Kidney Disease After Long-Term Hemodialysis: A Nationwide Population-Based Study
Session Information
- Anemia and Iron Metabolism: Clinical
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 202 Anemia and Iron Metabolism: Clinical
Author
- Yeh, Shu-Ching, Taipei Medical University Hospital, Taipei, Taiwan
Background
Iron supplementation and erythropoietin stimulating agents (ESAs) are essential for maintaining hemoglobin levels in hemodialysis (HD) patients. However, patients with autosomal-dominant polycystic kidney disease (PKD) have higher endogenous erythropoietin levels, so their recommended iron indices for HD patients may be different.
Methods
This cohort study from the Taiwan Renal Registry Data System (TWRDS) enrolled 84,219 HD patients with valid baseline iron profiles. We stratified mortality risk by presence of PKD recorded as underlying disease. The primary outcome was 3-year all-cause mortality. Predictors included time-averaged and baseline serum ferritin levels and transferrin saturation (TSAT, %). Cox regression multivariate analysis adjusting age, comorbidities, important relevant laboratories was used to pursue estimated all-cause hazard ratio (HR) of mortality.
Results
We enrolled 1346 HD patients with PKD and 82,873 HD patients without PKD. Mean ages were 56.2±13.2 and 61.7±13.5 years and follow-up durations were 2.62±0.89 and 2.28±1.04 years, respectively. Mortality risks for ferritin >800 ng/mL (HR=1.32; 95% confidence interval (CI)=1.21-1.43) or TSAT >50% (HR=1.34; 95% CI=1.18-1.52) were significantly higher among patients without PKD than those with normal iron indices. However, a U-shape curve between mortality and Ferritin/TSAT levels was not observed in patients with PKD. In sensitivity test, PKD patients underwent regular ESAs therapy showed no difference with non-ESAs user.
Conclusion
Iron indices affect mortality differently among patients with and without PKD. Iron supplementation, recommended serum ferritin levels, or TSAT should be monitored in HD patients especially without PKD. Clinicians should consider to treat anemia in HD patients individually, especially in PKD.