Iron Management, Anemia, and Kidney Transplant Waiting List Status

Iron metabolism disorders and anemia are common complications of end-stage renal disease and can impact the evaluation process for kidney transplantation. In a study published in Transplantation Proceedings, Marlena Kwiatkowska-Stawiarczyk and colleagues assessed iron metabolism in patients receiving hemodialysis in relation to their waiting list status.

The study included 5068 patients receiving hemodialysis. Of these, 449 were on the active waiting list and 4619 were ineligible. The researchers compared demographic and biochemical data, Charlson comorbidity index, duration of hemodialysis therapy, and hemoglobin, ferritin, and transferrin saturation levels in both patient groups.

The patients on the active waiting list were significantly younger than those who were not eligible for the waiting list (53.2 vs 67.2 years; P<.001). They also had a lower Charlson comorbidity index score (3.33 vs 4.42; P<.001).

Hemodialysis duration was similar between the active waiting list and ineligible groups (66.0 vs 63.2 months; P=.416). The incidence of anemia as defined by the World Health Organization (90.6% vs 91.2%) and Kidney Disease Improving Global Outcomes (72.4% vs 70.4%) were also comparable. The degree of anemia correction as related to hemoglobin concentration and transferrin saturation was comparable between the active waiting list versus ineligible patients; the average was 10.9 g/dL (P=.349) for hemoglobin concentration and 32.7% vs 33.4% (P=.513) for transferrin saturation.

The difference in ferritin concentration among active waiting list patients compared with waiting list-ineligible patients (554 ug/L vs 733 ug/L; P=.001) was statistically significant and could be the result of lower inflammation and less frequent blood transfusions. Lower ferritin levels could correspond with a lower risk of immunization and an increased chance of potential kidney transplantation.

Source: Transplantation Proceedings