Abstract: FR-PO0224
Narrow Transferrin Saturation and Ferritin Ranges Predict Optimal Hemoglobin Response to IV Iron in Patients with Nondialysis-Dependent CKD
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
- Fishbane, Steven, Northwell Health, New Hyde Park, New York, United States
- Pecoits-Filho, Roberto, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Bhatt, Sima, Disc Medicine Inc, Watertown, Massachusetts, United States
- Block, Geoffrey A., US Renal Care Inc, Plano, Texas, United States
- Buch, Akshay, Disc Medicine Inc, Watertown, Massachusetts, United States
- Chertow, Glenn M., Stanford University School of Medicine, Stanford, California, United States
- Fliser, Danilo, Universitatsklinikum des Saarlandes, Homburg, SL, Germany
- Reichel, Helmut, Nephrologisches Zentrum Villingen Schwenningen, Villingen-Schwenningen, BW, Germany
- Pergola, Pablo E., Renal Associates PA, San Antonio, Texas, United States
- Savage, Will, Disc Medicine Inc, Watertown, Massachusetts, United States
- Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Wish, Jay B., Indiana University School of Medicine, Indianapolis, Indiana, United States
Background
Anemia is a common complication of non-dialysis-dependent chronic kidney disease (NDD-CKD), often driven by inflammation and disrupted iron metabolism, but also associated with absolute deficiency. While transferrin saturation (TSAT) and ferritin guide treatment, they may not reliably reflect anemia mechanisms or predict outcomes.
Methods
We analyzed 703 German patients with NDD-CKD from CKDopps treated with IV iron without recent erythropoiesis-stimulating agent (ESA) use. Hemoglobin (Hb) response was modeled using spline regressions with TSAT-ferritin interactions. Contour plots illustrated Hb response patterns across biomarker levels.
Results
Mean age was 73 years; 51% were male; 46% had diabetes, 29% coronary artery disease. Hb response to IV iron varied nonlinearly with baseline TSAT and ferritin. Patients with TSAT <10% and ferritin <50 ng/mL showed the most consistent Hb gains. Higher levels of iron biomarkers were linked to reduced or absent response (orange and red in the figure), likely due to inflammation, marrow suppression, or hormonal deficiency. Contour plots identified a narrow TSAT-ferritin window (green and yellow in the figure) associated with optimal response.
Conclusion
TSAT and ferritin predict Hb response to IV iron in NDD-CKD, but efficacy appears limited to a narrower range (TSAT <10%, ferritin<75ng/ml) than current guidelines suggest. These results underscore the need for more individualized, physiology-based anemia management.
Funding
- Commercial Support – Disc Medicine