Yu Hongxue, Shao Xian, Guo Zhixin, Pang Mingzhen, Chen Shan, She Caoxiang, Cao Lisha, Luo Fan, Chen Ruixuan, Zhou Shiyu, Xu Xin, Nie Sheng
Division of Nephrology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, National Clinical Research Center for Kidney Disease, Southern Medical University, 1838 N Guangzhou Ave, Guangzhou, 510515, China.
Nutr J. 2025 Jan 15;24(1):7. doi: 10.1186/s12937-025-01072-1.
Iron deficiency is prevalent in patients with chronic kidney disease (CKD), even in those without anemia. However, the effects of iron deficiency on CKD progression and all-cause mortality in non-dialysis-dependent CKD (NDD-CKD) patients without anemia remain incompletely understood.
This multicenter retrospective nationwide cohort study included adult patients with non-anemia NDD-CKD from 24 hospitals across China. The study investigated the associations between serum ferritin or transferrin saturation (TSAT) levels and the risks of CKD progression and all-cause mortality.
Among 18,878 patients with NDD-CKD, 9,989 patients were included in the kidney outcome analysis, and 18,481 patients in the all-cause mortality analysis. Of the patients with the measurement, 2,450 (27.2%) had ferritin levels ≤ 100ng/mL and 2,440 (13.1%) had a TSAT level ≤ 20%. Compared with patients with TSAT level of > 20%, those with TSAT level of ≤ 20% had significantly higher risks of CKD progression (adjusted hazard ratio [aHR]: 1.66, 95% confidence intervals [CI]: 1.16-2.37; P = 0.005) and all-cause mortality (aHR: 2.21, 95% CI: 1.36-3.57; P = 0.001). The robustness of results was supported by subgroup analyses. However, there was no significant association found between ferritin levels and the risk of CKD progression or all-cause mortality (P > 0.05).
Iron deficiency was prevalent in NDD-CKD patients without anemia, and TSAT could be a modifiable risk factor of CKD progression and all-cause mortality. The screening of iron biomarkers, especially TSAT, in the early stage of NDD-CKD is important to assess and improve prognosis.
缺铁在慢性肾脏病（CKD）患者中普遍存在，即使在无贫血的患者中也是如此。然而，缺铁对非透析依赖型CKD（NDD-CKD）且无贫血患者的CKD进展和全因死亡率的影响仍未完全明确。
这项多中心全国性回顾性队列研究纳入了来自中国24家医院的非贫血NDD-CKD成年患者。该研究调查了血清铁蛋白或转铁蛋白饱和度（TSAT）水平与CKD进展风险和全因死亡率之间的关联。
在18878例NDD-CKD患者中，9989例患者纳入肾脏结局分析，18481例患者纳入全因死亡率分析。在有测量值的患者中，2450例（27.2%）铁蛋白水平≤100ng/mL，2440例（13.1%）TSAT水平≤20%。与TSAT水平>20%的患者相比，TSAT水平≤20%的患者CKD进展风险显著更高（校正风险比[aHR]：1.66，95%置信区间[CI]：1.16 - 2.37；P = 0.005）和全因死亡率更高（aHR：2.21，95%CI：1.36 - 3.57；P = 0.001）。亚组分析支持了结果的稳健性。然而，未发现铁蛋白水平与CKD进展风险或全因死亡率之间存在显著关联（P>0.05）。
缺铁在无贫血的NDD-CKD患者中普遍存在，TSAT可能是CKD进展和全因死亡率的一个可改变的风险因素。在NDD-CKD早期筛查铁生物标志物，尤其是TSAT，对于评估和改善预后很重要。
