Iron dysregulation in chronic kidney disease

Abstract

Anemia remains an important complication of patients with chronic kidney disease (CKD). Relative erythropoietin deficiency was assumed to be the main cause of anemia in CKD. In contrast, it is possible that iron dysregulation for erythropoiesis in CKD patients also affects not only anemia but also cardiovascular event or survival of these patients. A prospective observational study was conducted for 3 years on 1,000 maintenance hemodialysis patients. In time-dependent cox hazard analysis, we found the higher risks of cardiovascular disease (HR: 4.45, p<0.001) and all-cause mortality (HR: 5.8, p< 0.001) in patients with low transferrin saturation (TSAT) (<20%) and high ferritin levels (≥100 ng/ml) who are suspected to have iron dysregulation for erythropoiesis compared with patients with high TSAT and low ferritin level. From these results, we hypothesized that iron dysregulation in CKD patients is closely associated with various complications and survival. Moreover, iron administration should be approached with caution in patients who present with iron dysregulation for erythropoiesis.