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.
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Hyang Mo
authors: HM
authors: Koo
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Chan Ho
authors: CH
authors: Kim
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Fa Mee
authors: FM
authors: Doh
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Mi Jung
authors: MJ
authors: Lee
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Eun Jin
authors: EJ
authors: Kim
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Jae Hyun
authors: JH
authors: Han
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Ji Suk
authors: JS
authors: Han
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Hyung Jung
authors: HJ
authors: Oh
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Jung Tak
authors: JT
authors: Park
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Seung Hyeok
authors: SH
authors: Han
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Tae-Hyun
authors: TH
authors: Yoo
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea ; Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, Korea.
authors: Shin-Wook
authors: SW
authors: Kang
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D015996:Survival Rate; D014168:Transferrin / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D014168:Transferrin