Low transferrin saturation

• Published in: PloS one Vol. 15; no. 9; p. e0236277
• Main Authors: Kuragano, Takahiro, Joki, Nobuhiko, Hase, Hiroki, Kitamura, Kenichiro, Murata, Toshiaki, Fujimoto, Shouichi, Fukatsu, Atushi, Inoue, Toru, Itakura, Yukihiro, Nakanishi, Takeshi
• Format: Journal Article
• Language: English
• Published: Public Library of Science 02.09.2020
• Subjects: Cardiovascular diseases; Cerebrovascular disorders; Ferritin; Health aspects; Hemodialysis patients; Measurement; Prognosis; Risk factors; Transferrin; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0236277

Patients with high serum ferritin and low transferrin saturation (TSAT) levels could be considered as presenting with dysutilization of iron for erythropoiesis. However, the long-term safety of iron administration in these patients has not been well established. An observational multicenter study was performed over 3 years. In 805 patients undergoing maintenance hemodialysis (MHD), we defined dysutilization of iron for erythropoiesis in patients with lower TSAT (<20%) and higher ferritin ([greater than or equal to]100 ng/mL) levels. A time-dependent Cox hazard model was used for the evaluation of the association between dysutilization of iron for erythropoiesis and adverse events and survival. Patients with low TSAT levels showed an increased risk of cerebrovascular and cardiovascular disease (CCVD) and death compared to patients with normal or higher TSAT levels. Patients with low ferritin and high TSAT levels had a significantly lower risk of CCVD and death compared with patients with high ferritin and low TSAT levels. Higher TSAT levels were associated with male gender, age, the absence of diabetes, low levels of high-sensitivity CRP, and low [beta]2 microglobulin levels, but not with intravenous iron administration or ferritin levels. Although patients with low TSAT levels had a significantly higher risk of CCVD or death, high TSAT levels were not linked with iron administration. Patients, who were suspected of dysutilization of iron for erythropoiesis, had a higher risk of CCVD and death. The administration of iron should be performed cautiously for improving TSAT levels, as iron administration could sustain TSAT levels for a short term.