The Impact of Persistent Iron Overload and Ferritin Trend on the Clinical Outcome of Peritoneal Dialysis Patients: A...

Anemia is a major complication in chronic kidney disease. Although iron replacement therapies are commonly used, concerns about iron overload exist, for which data are limited, particularly in patients undergoing peritoneal dialysis (PD). This study investigated the impact of persistent iron overload and ferritin trends on clinical outcomes.

Single-center retrospective study.

A single dialysis unit; 586 new adult patients undergoing PD between 2011 and 2020; a subgroup of 345 patients was analyzed using their persistent or reversal of high iron status.

Change in iron status in 12 months after start of PD, classified into 5 groups.

Patient survival, technique survival, peritonitis-free survival, and number and length of hospitalization.

Cox regression models for survival analysis; linear regression after log transformation for hospitalization.

The 3-year patient survival rates for groups of patients with a decrease or increase in serum ferritin levels of ≤ 250 ng/mL, a decrease in serum ferritin levels of > 250-750 ng/mL, a decrease in serum ferritin levels of > 750 ng/mL, an increase in serum ferritin levels of > 250-750 ng/mL, and an increase in serum ferritin levels of > 750 ng/mL were 84.0%, 77.3%, 79.2%, 81.1%, and 67.3%, respectively (P = 0.007), although the association became insignificant after adjusting for confounding factors. Notably, 70.0% of a subgroup had persistent iron overload after the first year of PD. There were no significant differences in survival rates among the control, persistent iron overload, and reversal groups.

Single-center retrospective study.

A rise in serum ferritin levels of > 750 ng/mL was not associated with patient survival in a multivariable analysis. For patients with iron overload at the initiation of PD, the reversal of iron overload was not associated with any improvement in clinical outcomes.