Abstract: TH-PO1035
Clinical Outcomes of Iron Supplement Therapy in Nonanemic Female Patients with Stage 3 CKD and Low Serum Ferritin Levels: A Multi-Institutional TriNetX Analysis
Session Information
- Women's Health and Kidney Diseases
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Women's Health and Kidney Diseases
- 2200 Women's Health and Kidney Diseases
Authors
- Wu, Chia-Chao, Tri-Service General Hospital Department of Medicine, Taipei City, Taiwan
- Lu, Kuo-Cheng, Taipei Tzu Chi Hospital, Taipei City, Taiwan
Background
Iron deficiency without anemia (IDWA) is common among female patients with chronic kidney disease (CKD), yet clinical implications of iron therapy in this population remain uncertain. While iron supplementation is frequent in anemic CKD patients, evidence regarding its outcomes in non-anemic, iron-deficient individuals is limited and conflicting.
Methods
This retrospective cohort study utilized the multi-institutional TriNetX database to examine the 5-year outcomes of iron therapy in adult women with stage 3 CKD, normal hemoglobin (≥12 g/dL), normal mean corpuscular volume (MCV), and low serum ferritin (<30 ng/mL). Primary outcomes included all-cause mortality, major adverse cardiovascular events (MACE), acute kidney injury (AKI), pneumonia, fractures, and progression to advanced CKD (estimated glomerular filtration rate ≤30 mL/min/1.73 m2).
Results
We identified 2,964 eligible non-anemic patients with stage 3 CKD, low serum ferritin levels and normal MCV. Propensity score matching (1:1) was conducted on demographic variables to compare iron-treated (n=1,111) and untreated (n=1,111) cohorts. Over the 5 years follow-up in non-anemic female with stage 3 CKD and low ferritin levels, iron supplement was significantly associated with increased risks of MACE, AKI, pneumonia and CKD progression (log-rank p < 0.01, < 0.05, < 0.01, < 0.01 respectively). No significant difference in all-cause mortality or fracture risk was observed. Also, iron supplementation was associated with a significantly increased cumulative incidence of progression to advanced CKD in the 3 to 5 years follow-up period (p < 0.05). Data on transferrin saturation (TSAT) and the dosage of iron supplementation were unavailable.
Conclusion
In non-anemic, iron deficient women with stage 3 CKD and low ferritin levels, iron supplementation was linked to increased cardiovascular and renal risks without evident survival benefits. These findings emphasize the importance of individualized clinical decision-making and a cautious approach to iron therapy, especially in patients without anemia.