Wang Zi, Liu Guiling, Hao Li, Li Shaomei, Pei Huaying, Zhao Jinghong, Zhang Ying, Xiong Zibo, Liao Yumei, Li Ying, Lin Qiongzhen, Hu Wenbo, Li Yulin, Zheng Zhaoxia, Duan Liping, Fu Gang, Guo Shanshan, Zhang Beiru, Yu Rui, Sun Fuyun, Ma Xiaoying, Zhao Zhanzheng, Xiao Jing, Shen Yulan, Zhang Yong, Du Xuanyi, Ji Tianrong, Wang Caili, Deng Lirong, Yue Yingli, Chen Shanshan, Ma Zhigang, Li Yingping, Zuo Li, Zhao Huiping, Zhang Xianchao, Wang Xuejian, Liu Yirong, Gao Xinying, Chen Xiaoli, Li Hongyi, Du Shutong, Zhao Cui, Xu Zhonggao, Zhang Li, Chen Hongyu, Li Li, Wang Lihua, Yan Yan, Ma Yingchun, Wei Yuanyuan, Zhou Jingwei, Li Yan, Dong Jie
Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education, Beijing, China.
Renal Division, Department of Medicine, The Second Affiliated Hospital of Anhui Medical University, Anhui, China.
Clin Kidney J. 2024 Dec 30;18(4):sfae427. doi: 10.1093/ckj/sfae427. eCollection 2025 Apr.
Iron metabolism markers, such as transferrin saturation (TSAT) and ferritin, are crucial in anemia management in patients with CKD and those undergoing dialysis, yet optimal levels remain unelucidated.
We conducted a prospective multicenter cohort study using data from the nationwide Peritoneal Dialysis Telemedicine-based Management Platform (PDTAP) to analyze TSAT, ferritin, and hemoglobin (Hb) levels, and their associations with mortality in the peritoneal dialysis (PD) population.
Our study included 4429 PD patients, analyzing data through restricted cubic splines and Cox regression models, adjusted for multiple confounders. Non-linear associations between Hb levels and TSAT/ferritin were observed. Hb levels increased with TSAT up to 40%, then plateaued, whereas ferritin levels increased with the decline of Hb. Further, ferritin levels above 200 ng/mL were independently linked to increased mortality risk [hazard ratio (HR) 1.207, 95% confidence interval (CI) 1.134-1.286], with this effect decreasing as high-sensitivity C-reactive protein levels rose. This risk was notably significant in patients with a history of cardiovascular disease. A ferritin/Hb ratio >2 was associated with increased risk of mortality after adjusting for demographic, nutritional factors and erythropoiesis agents (HR 1.219, 95% CI 1.144-1.299). The ferritin/Hb ratio demonstrated superior predictive ability for iron responsiveness compared with ferritin alone.
Serum ferritin level exceeding 200 ng/mL was indepently associated with a higher risk of martality in Chinese PD population. Monitoring the ferritin/Hb ratio may help assess the relative iron content in the body and provide reference for iron supplementation among patients undergoing PD.
铁代谢标志物，如转铁蛋白饱和度（TSAT）和铁蛋白，在慢性肾脏病患者和透析患者的贫血管理中至关重要，但其最佳水平仍不明确。
我们进行了一项前瞻性多中心队列研究，使用来自全国腹膜透析远程医疗管理平台（PDTAP）的数据，分析TSAT、铁蛋白和血红蛋白（Hb）水平，以及它们与腹膜透析（PD）人群死亡率的关联。
我们的研究纳入了4429例PD患者，通过受限立方样条和Cox回归模型分析数据，并对多个混杂因素进行了校正。观察到Hb水平与TSAT/铁蛋白之间存在非线性关联。Hb水平随TSAT升高至40%时上升，然后趋于平稳，而铁蛋白水平随Hb下降而升高。此外，铁蛋白水平高于200 ng/mL与死亡风险增加独立相关[风险比（HR）1.207，95%置信区间（CI）1.134 - 1.286]，随着高敏C反应蛋白水平升高，这种影响减弱。这种风险在有心血管疾病史的患者中尤为显著。在调整了人口统计学、营养因素和促红细胞生成素后，铁蛋白/Hb比值>2与死亡风险增加相关（HR 1.219，95% CI 1.144 - 1.299）。与单独的铁蛋白相比，铁蛋白/Hb比值对铁反应性具有更好的预测能力。
血清铁蛋白水平超过200 ng/mL与中国PD人群较高的死亡风险独立相关。监测铁蛋白/Hb比值可能有助于评估体内相对铁含量，并为PD患者的铁补充提供参考。
