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Iron Deficiency Without Anemia Common in Peritoneal Dialysis Population

More patients receiving peritoneal dialysis experience iron deficiency without anemia than with anemia, and have a higher rate of early death, investigators reported at Kidney Week 2022, the annual meeting of the American Society of Nephrology, in Orlando, Florida.

Among 1365 patients new to peritoneal dialysis (mean age 59.7 years; 46.4% male; 49.1% with diabetes), iron deficiency occurred in 203 (14.9%), Vladimir Rigodon, clinical data analyst programmer at Fresenius Medical Care North America, and colleagues reported.

Transferrin saturation (TSAT) less than 20% indicated functional iron deficiency. Functional iron deficiency with vs without anemia occurred in 1.5% vs 5.2% of patients, the investigators reported. Functional iron deficiency without anemia was slightly more common in men than women. Low TSAT along with ferritin less than 200 ng/mL indicated absolute iron deficiency. Absolute iron deficiency with vs without anemia occurred in 1.8% vs 6.3%, they reported. Both types of absolute iron deficiency were more common in women.

“Anemic patients were infrequently iron deficient, which may suggest more active iron replacement triggered by low [hemoglobin],” Rigodon said in an interview with Renal & Urology News.

The 3-year all-cause mortality rate was highest with functional iron deficiency in the absence of anemia: 195.6 deaths per 1000 person-years, he reported. The death rate was similar for anemia with absolute or functional iron deficiency (142.8 and 142.4 deaths per 1000 person-years, respectively). It was lowest but still substantial with absolute iron deficiency in the absence of anemia (115.4 deaths per 1000 person-years).

“The main question to be answered is should we treat iron deficiency before the onset of anemia?” Rigodon said. “It seems logical because iron therapies would replete iron stores and may help delay the onset of anemia. Nonetheless, further studies will be needed to inform decision making beyond current guidelines, which are largely based on expert opinions.

“Within the MONitoring Dialysis Outcomes (MONDO) initiative group, we plan to look at iron deficiency and outcomes among a much larger peritoneal dialysis population, as well as in the hemodialysis population,” he noted.



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