Association of iron deficiency with kidney outcome and all-cause mortality in chronic kidney disease patients without anemia
Abstract Background 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 underst...
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2025-01-01
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| Series: | Nutrition Journal |
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| Online Access: | https://doi.org/10.1186/s12937-025-01072-1 |
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| author | Hongxue Yu Xian Shao Zhixin Guo Mingzhen Pang Shan Chen Caoxiang She Lisha Cao Fan Luo Ruixuan Chen Shiyu Zhou Xin Xu Sheng Nie |
| author_facet | Hongxue Yu Xian Shao Zhixin Guo Mingzhen Pang Shan Chen Caoxiang She Lisha Cao Fan Luo Ruixuan Chen Shiyu Zhou Xin Xu Sheng Nie |
| author_sort | Hongxue Yu |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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. Results 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). Conclusion 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. |
| format | Article |
| id | doaj-art-d2807f10774f456388ff367cd02fe9a0 |
| institution | Kabale University |
| issn | 1475-2891 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Nutrition Journal |
| spelling | doaj-art-d2807f10774f456388ff367cd02fe9a02025-01-19T12:11:17ZengBMCNutrition Journal1475-28912025-01-0124111010.1186/s12937-025-01072-1Association of iron deficiency with kidney outcome and all-cause mortality in chronic kidney disease patients without anemiaHongxue Yu0Xian Shao1Zhixin Guo2Mingzhen Pang3Shan Chen4Caoxiang She5Lisha Cao6Fan Luo7Ruixuan Chen8Shiyu Zhou9Xin Xu10Sheng Nie11Division of Nephrology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, National Clinical Research Center for Kidney Disease, Southern Medical UniversityDivision of Nephrology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, National Clinical Research Center for Kidney Disease, Southern Medical UniversityDivision of Nephrology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, National Clinical Research Center for Kidney Disease, Southern Medical UniversityDivision of Nephrology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, National Clinical Research Center for Kidney Disease, Southern Medical UniversityDivision of Nephrology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, National Clinical Research Center for Kidney Disease, Southern Medical UniversityDivision of Nephrology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, National Clinical Research Center for Kidney Disease, Southern Medical UniversityDivision of Nephrology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, National Clinical Research Center for Kidney Disease, Southern Medical UniversityDivision of Nephrology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, National Clinical Research Center for Kidney Disease, Southern Medical UniversityDivision of Nephrology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, National Clinical Research Center for Kidney Disease, Southern Medical UniversityDivision of Nephrology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, National Clinical Research Center for Kidney Disease, Southern Medical UniversityDivision of Nephrology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, National Clinical Research Center for Kidney Disease, Southern Medical UniversityDivision of Nephrology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, National Clinical Research Center for Kidney Disease, Southern Medical UniversityAbstract Background 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. Methods 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. Results 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). Conclusion 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.https://doi.org/10.1186/s12937-025-01072-1Iron deficiencySerum ferritinTransferrin saturationChronic kidney diseaseAnemia |
| spellingShingle | Hongxue Yu Xian Shao Zhixin Guo Mingzhen Pang Shan Chen Caoxiang She Lisha Cao Fan Luo Ruixuan Chen Shiyu Zhou Xin Xu Sheng Nie Association of iron deficiency with kidney outcome and all-cause mortality in chronic kidney disease patients without anemia Nutrition Journal Iron deficiency Serum ferritin Transferrin saturation Chronic kidney disease Anemia |
| title | Association of iron deficiency with kidney outcome and all-cause mortality in chronic kidney disease patients without anemia |
| title_full | Association of iron deficiency with kidney outcome and all-cause mortality in chronic kidney disease patients without anemia |
| title_fullStr | Association of iron deficiency with kidney outcome and all-cause mortality in chronic kidney disease patients without anemia |
| title_full_unstemmed | Association of iron deficiency with kidney outcome and all-cause mortality in chronic kidney disease patients without anemia |
| title_short | Association of iron deficiency with kidney outcome and all-cause mortality in chronic kidney disease patients without anemia |
| title_sort | association of iron deficiency with kidney outcome and all cause mortality in chronic kidney disease patients without anemia |
| topic | Iron deficiency Serum ferritin Transferrin saturation Chronic kidney disease Anemia |
| url | https://doi.org/10.1186/s12937-025-01072-1 |
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