Abstract: FR-PO0620
Elevated Serum Ferritin Levels and Infection-Related Mortality in Patients on Maintenance Hemodialysis: Ten-Year Outcomes of the Q-Cohort Study
Session Information
- Anemia: Global Burden, Disease Interactions, and Emerging Therapeutic Paradigms
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 200 Anemia and Iron Metabolism
Authors
- Hirashima, Yutaro, Matsuyama Sekijuji Byoin, Matsuyama, Ehime Prefecture, Japan
- Hiyamuta, Hiroto, Hamanomachi Byoin, Fukuoka, Fukuoka Prefecture, Japan
- Yamada, Shunsuke, Kyushu Daigaku, Fukuoka, Fukuoka Prefecture, Japan
- Kitamura, Hiromasa, Kyushu Daigaku, Fukuoka, Fukuoka Prefecture, Japan
- Taniguchi, Masatomo, Kyushu Daigaku, Fukuoka, Fukuoka Prefecture, Japan
- Tsuruya, Kazuhiko, Nara Daigaku, Nara, Nara Prefecture, Japan
- Ago, Tetsuro, Kyushu Daigaku, Fukuoka, Fukuoka Prefecture, Japan
- Nakano, Toshiaki, Kyushu Daigaku, Fukuoka, Fukuoka Prefecture, Japan
Background
Serum ferritin is routinely used to guide iron therapy in hemodialysis (HD) patients but also reflects inflammation and systemic illness. We examined whether higher ferritin levels, particularly clinically relevant thresholds, are associated with infection-related mortality in maintenance HD patients.
Methods
We analyzed 3,529 maintenance HD patients enrolled in the Q-Cohort Study between December 2006 and December 2007 and followed through December 2016. Baseline ferritin levels were evaluated by quartiles, clinical categories, a cutoff of 300 ng/mL, and natural log transformation. Infection-related mortality was assessed using cumulative incidence functions with non-infection-related death as the competing event, Cox proportional hazards models, Fine–Gray competing-risk models, restricted cubic spline analysis, and sensitivity analyses.
Results
During a median follow-up of 3,199 days, 1,748 deaths occurred, including 451 infection-related deaths. The cumulative incidence of infection-related death differed across ferritin quartiles (Gray's test P = 0.0005). In Cox models, the highest quartile showed a higher risk of infection-related mortality than the lowest quartile, with attenuation after multivariable adjustment. Ferritin ≥300 ng/mL was consistently associated with infection-related mortality across Cox models, including after adjustment for clinical, nutritional, and anemia-treatment-related factors (fully adjusted HR 1.37, 95% CI 1.10–1.71). Clinical category analyses showed that ferritin ≥500 ng/mL was particularly associated with infection-related mortality. Log-transformed ferritin and sensitivity analyses excluding ferritin >1000 ng/mL yielded similar findings. In Fine–Gray models, the associations were attenuated after multivariable adjustment. Restricted cubic spline analysis showed a gradual increase in risk at higher ferritin levels, without significant nonlinearity. Ferritin ≥300 ng/mL was also associated with all-cause mortality.
Conclusion
Higher serum ferritin levels, particularly ≥300 ng/mL, were associated with infection-related and all-cause mortality in maintenance HD patients in Cox models. However, these associations were attenuated in competing-risk models, suggesting that elevated ferritin may reflect systemic illness, inflammation, or overall mortality risk rather than a specific risk of infection-related mortality.
Acknowledgment
We thank the participants and investigators of the Q-Cohort Study for their valuable contributions.
Funding
- Government Support – Non-U.S.