Kidney Week

Abstract: SA-PO246

Transferrin Saturation (TSAT) and Clinical Outcome in Patients with Advanced CKD

Session Information

• Anemia and Iron Metabolism: Clinical
  November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Anemia and Iron Metabolism

• 202 Anemia and Iron Metabolism: Clinical

Authors

• Li, Xin, Karolinska Institutet, Stockholm, Sweden

Xin Li,

• Danielson Pistis, Kristin, Karolinska Institutet, Stockholm, Sweden

Kristin Danielson Pistis,

• Forsal, Innas, Karolinska Institutet, Stockholm, Sweden

Innas Forsal,

• Iseri, Ken, Karolinska Institutet, Stockholm, Sweden

Ken Iseri,

• Heimburger, Olof, Karolinska Institutet, Stockholm, Sweden

Olof Heimburger,

• Barany, Peter F., Karolinska Institutet, Stockholm, Sweden

Peter F. Barany,

• Lindholm, Bengt, Karolinska Institutet, Stockholm, Sweden

Bengt Lindholm,

• Qureshi, Abdul Rashid Tony, Karolinska Institutet, Stockholm, Sweden

Abdul Rashid Tony Qureshi,

• Stenvinkel, Peter, Karolinska Institutet, Stockholm, Sweden

Peter Stenvinkel,

Background

TSAT is frequently used in clinical practice as indicator of iron deficiency or overload, but its relationship with clinical outcomes in patients (pts) with advanced CKD is unclear. We investigated associations between TSAT and all-cause mortality in CKD5 non-dialysis (CKD5-ND) pts.

Methods

In 298 CKD5-ND pts (median age 56 years, 65% males, 38% cardiovascular disease, CVD, 31% diabetes, DM, median estimated glomerular filtration rate 6 (interquartile range, IQR, 5-8) ml/min/1.73²), biomarkers of iron status (plasma iron, TSAT, transferrin and ferritin), presence of CVD and protein energy wasting (PEW; subjective global assessment), Framingham's CVD risk score (FRS; as a composite index of traditional CVD risk factors) and systemic inflammation (high-sensitivity C-reactive protein, hsCRP, and interleukin-6, IL-6) were assessed. During median follow-up of 23 months, 87 (29%) pts died and 129 (43%) pts underwent renal transplantation. Pts were stratified into high (n=74) and low (n=224) TSAT quartile groups. All-cause mortality risk was analyzed with competing risk regression with renal transplantation as competing risk.

Results

TSAT (median 21% (IQR 16-28%) was negatively associated with age, DM, CVD, FRS, white blood cell count, hsCRP, IL-6, use of erythropoietin stimulating agents and iron supplementation, and positively associated with hemoglobin (Hb), ferritin and s-albumin. In competing risk analysis, low TSAT (sHR 1.84, 95% CI 1.0-3.36) was associated with higher all-cause mortality, independent of FRS. However, after further adjustments for FRS, ferritin, Hb, hsCRP and PEW, the association was not significant (p=0.07; sHR 1.72, 95% CI 0.95-3.09).

Conclusion

TSAT was inversely associated with all-cause mortality in CKD5-ND pts, independent of traditional CVD risk factors represented by FRS, underlining the importance of iron status in CKD. Nevertheless, degree of anemia, inflammatory status and PEW should be considered when analyzing TSAT as risk factor for adverse clinical outcomes in non-dialyzed pts with advanced CKD.

Funding

• Commercial Support – Baxter Healthcare