The relationship of initial transferrin saturation to cardiovascular parameters and outcomes in patients initiating dialysis

Hyang Mo Koo, Chan Ho Kim, Fa Mee Doh, Mi Jung Lee, Eun Jin Kim, Jae Hyun Han, Ji Suk Han, Hyung Jung Oh, Jung Tak Park, Seung Hyeok Han, Tae Hyun Yoo, Shin Wook Kang

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: The prognostic importance of anemia for cardiovascular (CV) events and mortality has been extensively investigated. However, little is known about the impact of transferrin saturation (TSAT), a marker reflecting the availability of iron for erythropoiesis, on clinical outcome in dialysis patients. Methods: A total of 879 anemic incident dialysis patients were recruited from the Clinical Research Center for End-Stage Renal Disease in Korea and were divided into 3 groups according to baseline TSAT of ≤20%, 20-40%, and ≤40%. Results: There were no differences in hemoglobin levels and the proportion of patients on erythropoiesis-stimulating agents or iron supplements among the 3 groups. During a mean follow-up duration of 19.3 months, 51 (5.8%) patients died. CV composite (11.71 vs. 5.55 events/100 patient-years, P = 0.001) and all-cause mortality rates (5.38 vs. 2.31 events/100 patient-years, P = 0.016) were significantly higher in patients with TSAT ≤20% compared to those with TSAT 20-40% (reference group). Cox regression analysis revealed that patients with TSAT ≤20% had 1.62- and 2.19-fold higher risks for CV composite outcome (P = 0.046) and all-cause mortality (P = 0.030). Moreover, TSAT ≤20% was significantly associated with left ventricular hypertrophy [odds ratio (OR) = 1.46], high-sensitivity C-reactive protein ≥3 mg/dL (OR = 2.09), N-terminal pro B-type natriuretic peptide ≥10000 pg/mL (OR = 2.04), and troponin-T≥0.1 ng/mL (OR = 2.02), on logistic regression analysis. Conclusions: Low TSAT was a significant independent risk factor for adverse clinical outcome in incident dialysis patients with anemia, which may be partly attributed to cardiac dysfunction and inflammation.

Original languageEnglish
Article numbere87231
JournalPloS one
Volume9
Issue number2
DOIs
Publication statusPublished - 2014 Feb 5

Fingerprint

Dialysis
transferrin
Transferrin
dialysis
odds ratio
Odds Ratio
erythropoiesis
Regression analysis
Iron
anemia
Hematinics
Mortality
Anemia
regression analysis
Troponin
Regression Analysis
Brain Natriuretic Peptide
Composite materials
iron
natriuretic peptides

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Koo, Hyang Mo ; Kim, Chan Ho ; Doh, Fa Mee ; Lee, Mi Jung ; Kim, Eun Jin ; Han, Jae Hyun ; Han, Ji Suk ; Oh, Hyung Jung ; Park, Jung Tak ; Han, Seung Hyeok ; Yoo, Tae Hyun ; Kang, Shin Wook. / The relationship of initial transferrin saturation to cardiovascular parameters and outcomes in patients initiating dialysis. In: PloS one. 2014 ; Vol. 9, No. 2.
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title = "The relationship of initial transferrin saturation to cardiovascular parameters and outcomes in patients initiating dialysis",
abstract = "Background: The prognostic importance of anemia for cardiovascular (CV) events and mortality has been extensively investigated. However, little is known about the impact of transferrin saturation (TSAT), a marker reflecting the availability of iron for erythropoiesis, on clinical outcome in dialysis patients. Methods: A total of 879 anemic incident dialysis patients were recruited from the Clinical Research Center for End-Stage Renal Disease in Korea and were divided into 3 groups according to baseline TSAT of ≤20{\%}, 20-40{\%}, and ≤40{\%}. Results: There were no differences in hemoglobin levels and the proportion of patients on erythropoiesis-stimulating agents or iron supplements among the 3 groups. During a mean follow-up duration of 19.3 months, 51 (5.8{\%}) patients died. CV composite (11.71 vs. 5.55 events/100 patient-years, P = 0.001) and all-cause mortality rates (5.38 vs. 2.31 events/100 patient-years, P = 0.016) were significantly higher in patients with TSAT ≤20{\%} compared to those with TSAT 20-40{\%} (reference group). Cox regression analysis revealed that patients with TSAT ≤20{\%} had 1.62- and 2.19-fold higher risks for CV composite outcome (P = 0.046) and all-cause mortality (P = 0.030). Moreover, TSAT ≤20{\%} was significantly associated with left ventricular hypertrophy [odds ratio (OR) = 1.46], high-sensitivity C-reactive protein ≥3 mg/dL (OR = 2.09), N-terminal pro B-type natriuretic peptide ≥10000 pg/mL (OR = 2.04), and troponin-T≥0.1 ng/mL (OR = 2.02), on logistic regression analysis. Conclusions: Low TSAT was a significant independent risk factor for adverse clinical outcome in incident dialysis patients with anemia, which may be partly attributed to cardiac dysfunction and inflammation.",
author = "Koo, {Hyang Mo} and Kim, {Chan Ho} and Doh, {Fa Mee} and Lee, {Mi Jung} and Kim, {Eun Jin} and Han, {Jae Hyun} and Han, {Ji Suk} and Oh, {Hyung Jung} and Park, {Jung Tak} and Han, {Seung Hyeok} and Yoo, {Tae Hyun} and Kang, {Shin Wook}",
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The relationship of initial transferrin saturation to cardiovascular parameters and outcomes in patients initiating dialysis. / Koo, Hyang Mo; Kim, Chan Ho; Doh, Fa Mee; Lee, Mi Jung; Kim, Eun Jin; Han, Jae Hyun; Han, Ji Suk; Oh, Hyung Jung; Park, Jung Tak; Han, Seung Hyeok; Yoo, Tae Hyun; Kang, Shin Wook.

In: PloS one, Vol. 9, No. 2, e87231, 05.02.2014.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The relationship of initial transferrin saturation to cardiovascular parameters and outcomes in patients initiating dialysis

AU - Koo, Hyang Mo

AU - Kim, Chan Ho

AU - Doh, Fa Mee

AU - Lee, Mi Jung

AU - Kim, Eun Jin

AU - Han, Jae Hyun

AU - Han, Ji Suk

AU - Oh, Hyung Jung

AU - Park, Jung Tak

AU - Han, Seung Hyeok

AU - Yoo, Tae Hyun

AU - Kang, Shin Wook

PY - 2014/2/5

Y1 - 2014/2/5

N2 - Background: The prognostic importance of anemia for cardiovascular (CV) events and mortality has been extensively investigated. However, little is known about the impact of transferrin saturation (TSAT), a marker reflecting the availability of iron for erythropoiesis, on clinical outcome in dialysis patients. Methods: A total of 879 anemic incident dialysis patients were recruited from the Clinical Research Center for End-Stage Renal Disease in Korea and were divided into 3 groups according to baseline TSAT of ≤20%, 20-40%, and ≤40%. Results: There were no differences in hemoglobin levels and the proportion of patients on erythropoiesis-stimulating agents or iron supplements among the 3 groups. During a mean follow-up duration of 19.3 months, 51 (5.8%) patients died. CV composite (11.71 vs. 5.55 events/100 patient-years, P = 0.001) and all-cause mortality rates (5.38 vs. 2.31 events/100 patient-years, P = 0.016) were significantly higher in patients with TSAT ≤20% compared to those with TSAT 20-40% (reference group). Cox regression analysis revealed that patients with TSAT ≤20% had 1.62- and 2.19-fold higher risks for CV composite outcome (P = 0.046) and all-cause mortality (P = 0.030). Moreover, TSAT ≤20% was significantly associated with left ventricular hypertrophy [odds ratio (OR) = 1.46], high-sensitivity C-reactive protein ≥3 mg/dL (OR = 2.09), N-terminal pro B-type natriuretic peptide ≥10000 pg/mL (OR = 2.04), and troponin-T≥0.1 ng/mL (OR = 2.02), on logistic regression analysis. Conclusions: Low TSAT was a significant independent risk factor for adverse clinical outcome in incident dialysis patients with anemia, which may be partly attributed to cardiac dysfunction and inflammation.

AB - Background: The prognostic importance of anemia for cardiovascular (CV) events and mortality has been extensively investigated. However, little is known about the impact of transferrin saturation (TSAT), a marker reflecting the availability of iron for erythropoiesis, on clinical outcome in dialysis patients. Methods: A total of 879 anemic incident dialysis patients were recruited from the Clinical Research Center for End-Stage Renal Disease in Korea and were divided into 3 groups according to baseline TSAT of ≤20%, 20-40%, and ≤40%. Results: There were no differences in hemoglobin levels and the proportion of patients on erythropoiesis-stimulating agents or iron supplements among the 3 groups. During a mean follow-up duration of 19.3 months, 51 (5.8%) patients died. CV composite (11.71 vs. 5.55 events/100 patient-years, P = 0.001) and all-cause mortality rates (5.38 vs. 2.31 events/100 patient-years, P = 0.016) were significantly higher in patients with TSAT ≤20% compared to those with TSAT 20-40% (reference group). Cox regression analysis revealed that patients with TSAT ≤20% had 1.62- and 2.19-fold higher risks for CV composite outcome (P = 0.046) and all-cause mortality (P = 0.030). Moreover, TSAT ≤20% was significantly associated with left ventricular hypertrophy [odds ratio (OR) = 1.46], high-sensitivity C-reactive protein ≥3 mg/dL (OR = 2.09), N-terminal pro B-type natriuretic peptide ≥10000 pg/mL (OR = 2.04), and troponin-T≥0.1 ng/mL (OR = 2.02), on logistic regression analysis. Conclusions: Low TSAT was a significant independent risk factor for adverse clinical outcome in incident dialysis patients with anemia, which may be partly attributed to cardiac dysfunction and inflammation.

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