Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan 24;12(1):1269.
doi: 10.1038/s41598-022-05200-3.

Association of anemia and iron parameters with mortality among prevalent peritoneal dialysis patients in Taiwan: the AIM-PD study

Ko-Lin Kuo  1   2   3 , Jia-Sin Liu  4 , Ming-Huang Lin  5 , Chih-Cheng Hsu  6   7   8   9 , Der-Cherng Tarng  10   11   12   13 ; Taiwan Society of Nephrology Renal Registry Data System Research Group
Collaborators, Affiliations

Association of anemia and iron parameters with mortality among prevalent peritoneal dialysis patients in Taiwan: the AIM-PD study

Ko-Lin Kuo et al. Sci Rep. .

Abstract

In 1996, the National Health Insurance Administration of Taiwan applied a restrictive reimbursement criteria for erythropoiesis-stimulating agents (ESAs) use in patients with chronic kidney disease. The maximal ESAs dosage allowed by insurance is capped at 20,000 U of epoetin per month. Nephrologists avoided the use of high ESA dosages to achieve a hemoglobin level of 10-11 g/dL using iron supplementation. We assessed the association of anemia and iron parameters with mortality among peritoneal dialysis (AIM-PD) patients. A retrospective cohort study was conducted based on the Taiwan Renal Registry Data System. From January 1, 2000 to December 31, 2008, we enrolled 4356 well-nourished PD patients who were older than 20 years and had been receiving PD for more than 12 months. All patients were divided into subgroups according to different hemoglobin, ferritin and transferrin saturation (TSAT) values. Patients were followed until death or December 31, 2008. In a median 2.9-year study period, 694 (15.9%) patients died. By multivariate adjustment, a hemoglobin level lower than 10 g/dL was significantly associated with a higher risk for all-cause and cardiovascular deaths. Moreover, a serum ferritin level higher than 800 ng/mL was associated with a higher risk for all-cause deaths, and a TSAT value between 20 and 50% was associated with the lowest all-cause mortality. In conclusions, we recommend avoiding a low hemoglobin level and a serum ferritin level of more than 800 ng/mL and maintaining a TSAT value between 20 and 50%, as these conditions were associated with lower risks of all-cause mortality in the AIM-PD study.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flowchart of patient selection.
Figure 2
Figure 2
Associations between hemoglobin values and all-cause (A), cardiovascular (B) mortality, respectively, in 4356 maintenance peritoneal dialysis patients.
Figure 3
Figure 3
Associations between serum ferritin levels and all-cause (A), cardiovascular (B), infection-related (C) and cancer-related (D) mortality, respectively, in 4356 maintenance peritoneal dialysis patients.
Figure 4
Figure 4
Associations between transferrin saturation (TSAT) values and all-cause (A), cardiovascular (B), infection-related (C) and cancer-related (D) mortality, respectively, in 4356 maintenance peritoneal dialysis patients.
See this image and copyright information in PMC

References

    1. Parfrey PS, et al. Double-blind comparison of full and partial anemia correction in incident hemodialysis patients without symptomatic heart disease. J. Am. Soc. Nephrol. 2005;16:2180–2189. doi: 10.1681/ASN.2004121039. - DOI - PubMed
    1. Singh AK, et al. Correction of anemia with epoetin alfa in chronic kidney disease. N. Engl. J. Med. 2006;355:2085–2098. doi: 10.1056/NEJMoa065485. - DOI - PubMed
    1. Drueke TB, et al. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N. Engl. J. Med. 2006;355:2071–2084. doi: 10.1056/NEJMoa062276. - DOI - PubMed
    1. Pfeffer MA, et al. A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N. Engl. J. Med. 2009;361:2019–2032. doi: 10.1056/NEJMoa0907845. - DOI - PubMed
    1. Besarab A, et al. The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin. N. Engl. J. Med. 1998;339:584–590. doi: 10.1056/NEJM199808273390903. - DOI - PubMed

Publication types