How well do we treat iron deficiency in hemodialysis patients with CKD-anemia? Association between serum ferritin and 1-year patient survival

Relevance: there is no consensus on which strategy of using intravenous iron for patients with CKD 5D is optimal in terms of the balance of benefit (achieving the target hemoglobin) and safety, and what is the role of serum ferritin in making decision to use iron. Aim: to assess the iron homeostasis in patients of the hemodialysis (HD) population of Saint Petersburg in the period 01.01.2017-01.01.2018; to investigate the association between high ferritin level and 1-year survival; to estimate changes in iron metabolism in 2017 vs. 2004. Methods: we studied the characteristics of 843 patients who received HD in 9 renal replacement therapy centers (RRT). The association of high ferritin and survival was evaluated using the Kaplan-Meier method. To compare the markers of the iron homeostasis in the HD patients in year 2017 versus 2004, we used our data published in 2005. Results: median ferritin was 351 [166; 634] µg/l, median annual iron dose was 1300 mg/year [400; 2400]; 34% of patients were in the target ferritin range 200-500 µg/l; 16% had ferritin >800. However, in some centers, the proportion of patients with ferritin >800 µg/l reached 38%, and those with >1200 ranged from 0 to 20.2%. Ferritin level did correlate with the Hb concentration. The survival rate tended to decrease with ferritin >800 µg/l (р=0.063, Wilcoxon-Breslow criterion), was lower for Hb <100 g/l vs. >100 (р<0.001), for CRP ≥10 mg/l vs. ≤4 (р<0.05), for albumin ≤37 g/l vs. >43 (р=0.001). In 2017, ferritin level increased slightly compared to 2004 (р=0.2). The median Hb was 110 [105; 115] g/l in 2017, compared to 95 [86; 106; р<0.001] in 2004. Conclusions: markers of the iron homeostasis in patients receiving HD in the RRT centers of St. Petersburg generally demonstrate a balanced approach to the use of intravenous iron. Aggressive tactics, aimed at ferritin levels >800 µg/l, should be avoided. There is a tendency of decreased survival rate for patients with ferritin >800 µg/l, and the dependence of survival rate on the level of Hb, C-reactive protein, and albumin. Comparison of the iron homeostasis markers in 2017 and 2004 showed a slight increase in ferritin level, higher proportion of patients reaching the target hemoglobin levels.

анемия, гемодиализ, железо, целевые уровни ферритина, выживаемость, anemia, hemodialysis, iron, target ferritin levels, survival rate

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