title: Low levels of serum ferritin lead to adequate hemoglobin levels and good survival in hemodialysis patients.
abstract: BACKGROUND
  The optimal level of serum ferritin (s-ft) for anemia control and good survival in hemodialysis (HD) patients remains unclear. A 10-year survey was performed to clarify the appropriate quantities of s-ft and investigate the relationships among s-ft, transferrin saturation (TSAT), and mortality in HD patients.
  
  
  METHODS
  HD outpatients (n = 125) treated with erythropoiesis-stimulating agents (ESA) were followed for 10 years. The ESA and low-dose iron supplement dosages were adjusted to maintain the hemoglobin (Hb) at 10-11 g/dl, according to Japanese guidelines. The Kaplan-Meier method, log-rank tests, and the Cox proportional hazards model were used for performing the statistical analyses. The interactions among the Hb, s-ft, and TSAT were analyzed using a multiple linear regression model. Patients with TSAT ≥20% were classified according to the s-ft cutoff values: group 1 (s-ft <30 ng/ml); group 2 (s-ft 30-80 ng/ml); group 3 (s-ft >80 ng/ml); TSAT <20% was a predictor of poor outcome.
  
  
  RESULTS
  The survival rate in group 2 was significantly higher than that in other groups (p = 0.013), and the Cox proportional hazards model analysis showed a good effect of low levels of s-ft on patients' survival. The multiple linear regression model showed a strong effect of s-ft on the Hb (log [s-ft], β-coefficient -0.45: 95% confidence interval -0.65 to -0.26, p < 0.001).
  
  
  CONCLUSIONS
  This study revealed that low levels of s-ft have a beneficial effect on the outcome of HD patients receiving ESA. Thus, the optimal s-ft level might be lower than that established previously for these patients.
authors.affiliation: Maeda Institute of Renal Research, Division of Nephrology, Department of Internal Medicine, Department of Medicine, Kidney Center, Kawasaki City, Japan.
authors.forename: Chie
authors.initials: C
authors.lastname: Ogawa
authors.forename: Ken
authors.initials: K
authors.lastname: Tsuchiya
authors.forename: Fumiyoshi
authors.initials: F
authors.lastname: Kanda
authors.forename: Teiryo
authors.initials: T
authors.lastname: Maeda
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood*; D002423:Cause of Death; D019587:Dietary Supplements; D005260:Female; D005293:Ferritins / Q000097:blood*; D006397:Hematinics / Q000008:administration & dosage; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007501:Iron / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D014168:Transferrin / Q000378:metabolism*
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D014168:Transferrin; D005293:Ferritins; D007501:Iron