title: Serum ferritin predicts prognosis in hemodialysis patients: the Nishinomiya study.
abstract: BACKGROUND
  The mortality in end-stage renal disease patients with dialysis remains high. Serum ferritin is a useful surrogated marker of iron storage. It has not been elucidated whether the ferritin level can predict the prognosis of patients with dialysis but without obvious inflammation. To clarify whether the ferritin level is involved in the prognosis in dialyzed patients, we investigated the relation between ferritin level and mortality in hemodialyzed patients during long-term follow-up.
  
  
  METHODS
  Ninety stable hemodialyzed patients were enrolled and followed for 107 months. Serum ferritin and related factors (dialysis, nutrition, iron metabolism, inflammation and oxidative stress) were measured and used for statistical analysis. Survival analysis of death for ferritin as a predictive variable was performed.
  
  
  RESULTS
  A relatively high level of serum ferritin (> or =100 ng/ml) was associated with poor prognosis after adjustment for basic factors and C reactive protein (hazard ratio, 4.18). Hemoglobin-stratified Kaplan-Meier analysis showed that the prognosis for the high ferritin-low hemoglobin group was significantly poor.
  
  
  CONCLUSIONS
  This study suggests that the ferritin level is closely associated with high mortality in hemodialyzed patients. Further studies investigating the pathological role of iron storage on survival of hemodialyzed patients with large populations are needed.
authors.affiliation: Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan. cherry39@hyo-med.ac.jp
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Hasuike
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nonoguchi
authors.forename: Masanori
authors.initials: M
authors.lastname: Tokuyama
authors.forename: Mai
authors.initials: M
authors.lastname: Ohue
authors.forename: Takanori
authors.initials: T
authors.lastname: Nagai
authors.forename: Mana
authors.initials: M
authors.lastname: Yahiro
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Nanami
authors.forename: Yoshinaga
authors.initials: Y
authors.lastname: Otaki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakanishi
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D005293:Ferritins / Q000097:blood*; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D005293:Ferritins
references.citation: Clin Biochem. 2002 Oct;35(7):523-9
references.pmid: 12493580
references.citation: J Am Soc Nephrol. 2005 Oct;16(10):3070-80
references.pmid: 16033854
references.citation: Arterioscler Thromb Vasc Biol. 2005 Dec;25(12):2495-501
references.pmid: 16224057
references.citation: Am J Kidney Dis. 2004 Jun;43(6):1030-9
references.pmid: 15168383
references.citation: Am J Physiol Gastrointest Liver Physiol. 2002 Mar;282(3):G403-14
references.pmid: 11841990
references.citation: Am J Kidney Dis. 2001 Mar;37(3):564-72
references.pmid: 11228181
references.citation: Ther Apher Dial. 2011 Feb;15(1):28-33
references.pmid: 21272249
references.citation: Ther Apher Dial. 2004 Dec;8(6):443-59
references.pmid: 15663544
references.citation: Biochem Med. 1976 Apr;15(2):212-6
references.pmid: 962904
references.citation: Blood Rev. 1990 Dec;4(4):259-69
references.pmid: 2076473
references.citation: Am J Med Sci. 2009 Mar;337(3):188-94
references.pmid: 19282675
references.citation: Philos Trans R Soc Lond B Biol Sci. 1984 Feb 13;304(1121):551-65
references.pmid: 6142491