Abstract: PO0996
Low Serum Transferrin Saturation Is Associated with Incident Diabetes in Veterans with CKD
Session Information
- Diabetic Kidney Disease: Clinical - 1
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 602 Diabetic Kidney Disease: Clinical
Authors
- Cho, Monique E., George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, United States
- Hansen, Jared, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, United States
- Cheung, Alfred K., George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, United States
- Greene, Tom, University of Utah Health, Salt Lake City, Utah, United States
Background
Chronic kidney disease (CKD) is associated with increased risk for new-onset diabetes. Decreased circulating iron, as expressed by low transferrin saturation (Tsat), is associated with diabetes in the general population, but it has not been investigated if Tsat or ferritin is independently associated with incident diabetes in CKD.
Methods
We developed a historical cohort using the Veterans Affairs Informatics and Computing Infrastructure. We identified non-diabetic Veterans with CKD (MDRD eGFR <60 mL/min/1.73m2) with at least one set of iron indices between 2006-2015. Veterans with diabetes, end-stage renal disease, genetic or chronic disorders affecting iron metabolism, or those who received intravenous iron or erythropoietin stimulating agents within 3 months of the iron indices were excluded. A generalized additive Cox model was applied to the cohort to explore the joint dose-response relationship of the hazard for incident diabetes following the iron assay. A contour surface plot relating the covariate-adjusted hazard for incident diabetes to both Tsat and ferritin was developed using cubic regression splines.
Results
Of the 1,159,371 Veterans with CKD, 54,990 met the inclusion criteria. The mean±SD for age and eGFR were 73.8 ± 11.8 years and 43.8 ± 10.4 mL/min/1.73 m2, respectively. The median (IQR) Tsat and ferritin values were 23.0 (16.9, 29.7) % and 112.1 (56.0, 210.0) ng/mL. Over the mean follow-up period of 4 years, the risk of diabetes was inversely associated with Tsat, while it was positively correlated with serum ferritin. The surface contour map suggests that lower Tsat range (<20%) has a stronger relationship with diabetic risk than serum ferritin.
Conclusion
In Veterans with pre-dialysis CKD, decreased Tsat is closely associated with incident diabetes risk, while increased ferritin exacerbates the risk.
Funding
- Veterans Affairs Support