Abstract: FR-PO0225
Investigation of the Serum Ferritin Thresholds Necessary for Erythropoiesis and Iron Sufficiency in Patients on Hemodialysis
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
- Ogawa, Chie, Maeda Institute of Renal Research, Kawasaki, Kanagawa, Japan
- Tsuchiya, Ken, Department of Nephrology, Tokyo Women’s Medical University, Tokyo, Japan
- Morito, Taku, Maeda Institute of Renal Research, Kawasaki, Kanagawa, Japan
- Maeda, Kunimi, Maeda Institute of Renal Research, Kawasaki, Kanagawa, Japan
Background
We previously reported that total body iron (TBI), defined as the sum of RBC iron and iron stores, reflects iron sufficiency during oral iron therapy, where absorption is suppressed by mucosal block once stores are replete. Serum ferritin (Ft) is commonly used as a guide for iron supplementation in hemodialysis (HD) patients, but Ft level indicating iron sufficiency and the amount needed for effective erythropoiesis remain unclear.
Methods
We analyzed data from 101 OIRT courses in 79 HD patients. OIRT was initiated when Ft was <60 ng/mL and Hb <12 g/dL, and continued for at least seven months. Target Hb was 10–12 g/dL per Japanese guidelines. To examine the relationship between changes in Hb and ferritin (ΔHb, ΔFt) from 4 months (4M; point of TBI stabilization) to 7 months (7M), a multivariable linear regression analysis was performed, adjusting for changes in TBI (ΔTBI). Additionally, Bonferroni correction was applied for multiple comparisons of mean values at 0, 4, and 7 M.
Results
This study analyzed 101 OIRT courses in 79 HD patients. Median age and dialysis vintage were 70.7 and 7.2 years, respectively. Of the 101 OIRT courses, 74 were in male patients, and 33.7% had diabetic nephropathy. Hb showed a significant increase by 4M, followed by a slight downward trend at 7M. Ft levels increased significantly through to 7M. There was a significant inverse association between ΔHb and ΔFt (β = –36.9; 95% CI: -40.1 to -31.7; R2 = 0.76; P <0.01) (Fig. 1). The median Ft at 4M was 57.5 ng/mL (IQR: 37.8–74.1). A significant inverse correlation was also observed between ΔHb and Ft at 7M (P < 0.01), indicating that increases in Ft at 7M were associated with decreases in Hb. When ΔHb was 0 g/dL, the estimated serum ferritin was 68.0 ng/mL (95% CI: 60.1–75.8; P < 0.01).
Conclusion
This study suggests that an increase of 1 g/dL in Hb requires approximately 30–40 ng/mL of Ft. Furthermore, during Hb stability, a Ft level of approximately 40–80 ng/mL may indicate iron sufficiency.
Relationship of ΔFt with ΔHb (ΔTBI fixed at mean value).