High Serum Ferritin Levels Are Associated with Sarcopenia in Patients Undergoing Chronic Hemodialysis

Background/Objectives: Patients undergoing hemodialysis frequently receive oral or intravenous iron supplementation to treat iron-deficiency anemia and enhance the efficacy of erythropoiesis-stimulating agents. However, this approach may lead to iron overload. Experimental studies have suggested that iron overload may contribute to the development of sarcopenia through oxidative stress and inflammation. This study aimed to investigate the association between iron status and sarcopenia in patients undergoing hemodialysis. Methods: Serum ferritin levels were measured, and sarcopenia was assessed using the Asian Working Group for Sarcopenia criteria in 104 stable outpatients undergoing maintenance hemodialysis therapy. Results: Sarcopenia was identified in 25 (24.0%) patients. Serum ferritin levels were significantly higher in patients with sarcopenia than in those without (median: 170.6 ng/mL vs. 92 ng/mL, p = 0.023). An increase of 10 ng/mL in serum ferritin levels was independently associated with sarcopenia. The high-ferritin group (≥132 ng/mL as a cutoff value determined using receiver operating characteristic curve analysis) exhibited a higher prevalence of sarcopenia compared with the low-ferritin group (37.3% vs. 11.3%, p = 0.001). Furthermore, serum ferritin levels were negatively correlated with skeletal muscle mass and skeletal muscle strength, which constitute the components of the sarcopenia diagnostic criteria. Conclusions: Elevated serum ferritin levels were independently associated with sarcopenia in patients undergoing hemodialysis. This finding implies that excessive iron supplementation may contribute to the progression of sarcopenia. Routine evaluation of iron status and careful assessment of the necessity for iron therapy are recommended in this population.