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The Relationship of Initial Transferrin Saturation to Cardiovascular Parameters and Outcomes in Patients Initiating Dialysis

 Hyang Mo Koo  ;  Chan Ho Kim  ;  Fa Mee Doh  ;  Mi Jung Lee  ;  Eun Jin Kim  ;  Jae Hyun Han  ;  Ji Suk Han  ;  Hyung Jung Oh  ;  Jung Tak Park  ;  Seung Hyeok Han  ;  Tae-Hyun Yoo  ;  Shin-Wook Kang 
 PLOS ONE, Vol.9(2) : e87231, 2014 
Journal Title
Issue Date
Adult ; Aged ; Anemia*/blood ; Anemia*/etiology ; Anemia*/mortality ; Anemia*/therapy ; Biomarkers/blood ; Female ; Humans ; Kidney Failure, Chronic*/blood ; Kidney Failure, Chronic*/mortality ; Kidney Failure, Chronic*/therapy ; Male ; Middle Aged ; Renal Dialysis* ; Survival Rate ; Transferrin/metabolism*
BACKGROUND: The prognostic importance of anemia for cardiovascular (CV) events and mortality has been extensively investigated. However, little is known about the impact of transferrin saturation (TSAT), a marker reflecting the availability of iron for erythropoiesis, on clinical outcome in dialysis patients. METHODS: A total of 879 anemic incident dialysis patients were recruited from the Clinical Research Center for End-Stage Renal Disease in Korea and were divided into 3 groups according to baseline TSAT of ≤20%, 20-40%, and >40%. RESULTS: There were no differences in hemoglobin levels and the proportion of patients on erythropoiesis-stimulating agents or iron supplements among the 3 groups. During a mean follow-up duration of 19.3 months, 51 (5.8%) patients died. CV composite (11.71 vs. 5.55 events/100 patient-years, P = 0.001) and all-cause mortality rates (5.38 vs. 2.31 events/100 patient-years, P = 0.016) were significantly higher in patients with TSAT ≤20% compared to those with TSAT 20-40% (reference group). Cox regression analysis revealed that patients with TSAT ≤20% had 1.62- and 2.19-fold higher risks for CV composite outcome (P = 0.046) and all-cause mortality (P = 0.030). Moreover, TSAT ≤20% was significantly associated with left ventricular hypertrophy [odds ratio (OR)  = 1.46], high-sensitivity C-reactive protein ≥3 mg/dL (OR = 2.09), N-terminal pro B-type natriuretic peptide ≥10000 pg/mL (OR  = 2.04), and troponin-T≥0.1 ng/mL (OR  = 2.02), on logistic regression analysis. CONCLUSIONS: Low TSAT was a significant independent risk factor for adverse clinical outcome in incident dialysis patients with anemia, which may be partly attributed to cardiac dysfunction and inflammation.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Koo, Hyang Mo(구향모)
Kim, Eun Jin(김은진)
Kim, Chan Ho(김찬호)
Doh, Fa Mee(도화미) ORCID logo https://orcid.org/0000-0002-4780-6728
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Oh, Hyung Jung(오형중)
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Lee, Mi Jung(이미정)
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
Han, Jae Hyun(한재현)
Hahn, Jee Sook(한지숙)
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