Abstract: FR-PO0237
PDOPPS International Anemia Prevalence and Management in People Receiving Peritoneal Dialysis
Session Information
- Anemia and Iron Metabolism
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 200 Anemia and Iron Metabolism
Authors
- Spencer, Sebastian, University of Hull, Hull, England, United Kingdom
- Lambie, Mark, Keele University, Newcastle-under-Lyme, England, United Kingdom
- Bhandari, Sunil, Hull University Teaching Hospitals NHS Trust, Hull, England, United Kingdom
Background
Optimal anemia management in peritoneal dialysis (PD) remains uncertain, with substantial variation in clinical practice across countries. We aimed to describe the evolution over time of iron indices in people receiving PD, the determinants of this and the associations of these indices with mortality.
Methods
We analyzed baseline data from adult PD patients enrolled in the Peritoneal Dialysis Outcomes and Practice Patterns Study across seven countries: Australia/New Zealand, Japan, USA, UK, Thailand, and Canada. Cross-sectional comparisons were made for hemoglobin, ferritin, transferrin saturation (TSAT), serum iron, total iron-binding capacity (TIBC), and use of erythropoiesis-stimulating agents and iron (oral or intravenous). Time-varying Cox models with restricted cubic splines were used to examine associations of iron, TSAT, TIBC and ferritin with all-cause, cardiovascular and infection-related mortalities.
Results
The analysis included 7,930 patients. Time-varying Cox models demonstrated U-shaped associations between serum iron, TSAT and TIBC with all-cause, cardiovascular, and infection-related mortality. Ferritin showed a monotonic increase in hazard, particularly for all-cause and cardiovascular mortality, likely reflecting its dual role as a marker of iron stores and inflammation. These findings support a multi-marker approach to iron assessment, rather than reliance on ferritin alone.
Conclusion
High and low levels of iron, TSAT, and TIBC were linked to increased mortality. In contrast, ferritin showed a steady increase in hazard, particularly for all-cause and cardiovascular mortality, likely due to its inflammatory nature. These findings suggest ferritin is a poor standalone marker of iron status in peritoneal dialysis patients.
Association between iron biomarkers and mortality