Abstract: SA-PO0359
Dual Prognostic Implications of Total Iron-Binding Capacity in Hemodialysis: A J-DOPPS Cohort Study
Session Information
- Dialysis: Epidemiology and Facility Management
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Eriguchi, Masahiro, Nara Kenritsu Ika Daigaku, Kashihara, Nara Prefecture, Japan
- Orihara, Shunichito, Tokyo Ika Daigaku, Shinjuku, Tokyo, Japan
- Onishi, Yoshihiro, Institute for Health Outcomes and Process Evaluation Research, Kyoto, Japan
- Tsuruya, Kazuhiko, Nara Kenritsu Ika Daigaku, Kashihara, Nara Prefecture, Japan
Background
Transferrin saturation (TSAT) is commonly used to assess iron status in dialysis patients, while total iron-binding capacity (TIBC), derived from transferrin levels, remains underutilized. TIBC increases with iron deficiency and is associated with thrombosis risk, whereas low TIBC reflects poor nutritional status and worse outcomes. We aimed to evaluate the prognostic significance of TIBC in maintenance hemodialysis (HD) patients.
Methods
We analyzed data from 5,604 HD patients in phases 4–7 of the Japanese Dialysis Outcomes and Practice Patterns Study (J-DOPPS). Patients were classified into TIBC quintiles and stratified by serum albumin (<3.8 or ≥3.8 g/dL) or C-reactive protein (CRP, <0.1 or ≥0.1 mg/dL). The outcomes were all-cause mortality, cardiovascular and thrombotic events. Associations were assessed using Cox proportional hazards models and spline analyses.
Results
During a mean follow-up of 2.0 years, 622 deaths were recorded. Higher TIBC quintiles were associated with younger age, iron deficiency (low TIBC and ferritin), lower CRP, and better nutritional markers. In the low-albumin and high-CRP groups, mortality decreased progressively with increasing TIBC quintiles (trend P = 0.003 and P < 0.0001, respectively), whereas no clear trend was observed in the high-albumin or low-CRP groups. Fully adjusted Cox models showed no significant differences in mortality across TIBC quintiles. However, spline analysis demonstrated increased mortality at TIBC levels above 300 μg/dL, but only in patients with hypoalbuminemia or elevated CRP. (Figure)
Conclusion
Elevated TIBC, reflecting iron deficiency, was associated with higher mortality only in patients with hypoalbuminemia or inflammation. These findings highlight the complex, context-dependent prognostic value of TIBC in hemodialysis patients.
Funding
- Commercial Support – Astellas Pharma Inc.