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. 2025 Oct 2.
doi: 10.1007/s40620-025-02363-w. Online ahead of print.

Longitudinal associations between iron status and patient-reported outcomes in incident dialysis patients: a DOMESTICO substudy

Osman Mahic #  1   2 , Thomas S van Lieshout #  3   4 , Alferso C Abrahams  1 , Esmee Driehuis  1   5 , Ellen K Hoogeveen  6   7   8 , Michele F Eisenga  9 , Robin W M Vernooij  1   2 , Brigit C van Jaarsveld  5   10 ; DOMESTICO study group
Collaborators, Affiliations

Longitudinal associations between iron status and patient-reported outcomes in incident dialysis patients: a DOMESTICO substudy

Osman Mahic et al. J Nephrol. .

Abstract

Background: More liberal use of iron therapy is favored in dialysis patients based on lower erythropoietin need and clinical outcomes. However, it remains unclear whether higher iron stores are associated with better patient-reported outcomes. We assessed the longitudinal associations of ferritin and transferrin saturation (TSAT) levels with patient-reported outcomes in incident dialysis patients.

Methods: This prospective cohort study included incident dialysis patients who had completed at least one patient-reported outcome questionnaire and had undergone a laboratory assessment (e.g., ferritin, transferrin saturation, hemoglobin) within the first year of dialysis. The primary outcome was health-related quality of life (HRQoL), measured using the 12-Item Short Form (SF-12) survey. Secondary outcomes were the presence of anemia-related symptoms, measured using the Dialysis Symptom Index. We used sequential conditional mean models to adjust for baseline and time-varying confounding.

Results: We included 1069 incident dialysis patients, of whom 76% initiated hemodialysis. The mean (SD) age was 64.0 (14.2) years and 34% were female. Over a 1-year follow-up, patients with ferritin levels < 200, > 500 - 700, and > 700 ng/mL did not have a significantly different HRQoL compared to those with levels between 200 - 500 ng/mL, chosen as reference. Similarly, patients with TSAT levels < 20 or ≥ 40% did not have a significantly different HRQoL compared to those with levels between 20 - 39%. No significant differences were found in the odds of experiencing fatigue, shortness of breath, muscle cramps or restless legs between the ferritin and TSAT groups.

Conclusion: Differences in iron status parameters were not associated with differences in patient-reported outcomes during the first year of dialysis. Our findings therefore suggest that decisions on iron therapy should be guided by target hemoglobin levels and clinical outcomes in dialysis patients.

Keywords: Anemia; Hemodialysis; Iron deficiency; Kidney failure; Patient-reported outcomes; Peritoneal dialysis.

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Conflict of interest statement

Declarations. Conflict of interest: AA has received speaker honoraria from Baxter Healthcare, Fresenius Medical Care, AstraZeneca and Cablon Medical. ME has declared receiving consultant fees from Vifor Pharma and Cablon Medical; received grants from Cablon Medical and Astellas; serving on the Advisory Board for Cablon Medical, GlaxoSmithKline and Medice; and receiving speaker fees from Vifor Pharma, Pharmacosmos, and Astellas (In all instances all to employer). BJ has received speaker honoraria from Fresenius Medical Care and CSL Vifor. All other authors have nothing to disclose. Ethical approval: All patients included provided written informed consent upon enrollment. Ethical approval was obtained from the medical research ethics committee of the VU University Medical Center Amsterdam (no.: NL63277.029.17). The medical ethics committees of all participating dialysis centers approved the study. The study is conducted according to the principles of the Declaration of Helsinki. The DOMESTICO study is registered in the Dutch Trial Register (no: NL6519). Human and animal rights: The study complies with the guidelines for human studies. Informed consent: All participants provided informed consent prior to their participation.

References

    1. Stauffer ME, Fan T (2014) Prevalence of Anemia in Chronic Kidney Disease in the United States. PLoS ONE 9(1):e84943. https://doi.org/10.1371/journal.pone.0084943 - DOI - PubMed - PMC
    1. Babitt JL, Lin HY (2012) Mechanisms of Anemia in CKD. J Am Soc Nephrol 23(10):1631–1634. https://doi.org/10.1681/asn.2011111078 - DOI - PubMed - PMC
    1. Kidney Disease: Improving Global Outcomes (KDIGO) Anemia Work Group. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney Inter Suppl. 2012; 2: 279–335.
    1. Dev S, Babitt JL (2017) Overview of iron metabolism in health and disease. Hemodial Int. https://doi.org/10.1111/hdi.12542 - DOI - PubMed - PMC
    1. Paul BT, Manz DH, Torti FM, Torti SV (2016) Mitochondria and Iron: current questions. Expert Rev Hematol 10(1):65–79. https://doi.org/10.1080/17474086.2016.1268047 - DOI - PubMed - PMC

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