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Kidney Week

Abstract: TH-PO698

Iron Deficiency, Anemia, and Health-Related Quality of Life in Kidney Transplant Recipients

Session Information

  • Anemia and Iron Metabolism
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism

Authors

  • Knobbe, Tim J., University Medical Center Groningen, departent of Internal Medicine, Division of Nephrology, Groningen, Netherlands
  • Kremer, Daan, University Medical Center Groningen, departent of Internal Medicine, Division of Nephrology, Groningen, Netherlands
  • Vinke, Joanna Sophia Jacoline, University Medical Center Groningen, departent of Internal Medicine, Division of Nephrology, Groningen, Netherlands
  • Annema, Coby, University Medical Center Groningen, Department of Health Sciences, Section of Nursing Research, Groningen, Netherlands
  • De Borst, Martin H., University Medical Center Groningen, departent of Internal Medicine, Division of Nephrology, Groningen, Netherlands
  • Berger, Stefan P., University Medical Center Groningen, departent of Internal Medicine, Division of Nephrology, Groningen, Netherlands
  • Bakker, Stephan J.L., University Medical Center Groningen, departent of Internal Medicine, Division of Nephrology, Groningen, Netherlands
  • Eisenga, Michele F., University Medical Center Groningen, departent of Internal Medicine, Division of Nephrology, Groningen, Netherlands

Group or Team Name

  • TransplantLines Investigators
Background

Current guidelines focus on treatment of anemia to improve health-related quality of life (HRQoL) among kidney transplant recipients (KTRs), with limited effects. Iron fulfills a myriad of functions besides stimulating erythropoiesis, and there is increasing consensus that iron deficiency, rather than anemia alone, may be a promising target to improve HRQoL. However, epidemiological support for this notion is sparse. We therefore investigated the association of iron deficiency with HRQoL in KTRs, adjusting for co-existing anemia.

Methods

Data of KTRs (≥1 year after transplantation) from the TransplantLines Biobank and Cohort Study were used. Iron deficiency was defined as serum transferrin saturation <20% and ferritin <100 µg/L. Anemia was defined as Hb <13 g/dL (M) or <12 g/dL (F). HRQoL was assessed using the validated Short Form-36 questionnaire.

Results

A total of 814 KTRs (62% male, mean age 56±13 years) were included at a median of 3 [1-10] years after transplantation. In total, 229 (28%) KTRs suffered from iron deficiency and 237 (29%) were anemic. In linear regression analyses, both iron deficiency and anemia were associated with physical (B -4.82, 95% CI -8.06 to -1.59, p=0.004 and B -3.45, 95% CI -6.77 to -0.13, p=0.042, respectively) and mental (B -3.63, 95% CI -6.42 to -0.84, p=0.011 and B -1.22, 95% CI -4.09 to 1.64, p=0.4, respectively) HRQoL, independent of age, sex, eGFR, time since transplantation, diabetes mellitus, pre-emptive transplantation, living donor, calcineurin inhibitor use, angiotensin receptor blocker use and ACE inhibitor use. In addition, the associations between iron deficiency and HRQoL remained materially unchanged after additional adjustment for anemia (physical: -4.43, 95% CI -7.69 to -1.16, p=0.008; mental: B -3.53, 95% CI -6.35 to -0.71, p=0.014).

Conclusion

Iron deficiency, independent of anemia, is associated with lower physical and mental HRQoL among KTRs. These data highlight the need for interventional studies investigating whether correction of iron deficiency improves HRQoL among KTRs, even in the absence of anemia.

Funding

  • Commercial Support