TY - JOUR
T1 - Longitudinal associations between iron status and patient-reported outcomes in incident dialysis patients
T2 - a DOMESTICO substudy
AU - Mahic, Osman
AU - van Lieshout, Thomas S.
AU - the DOMESTICO study group
AU - Abrahams, Alferso C.
AU - Driehuis, Esmee
AU - Hoogeveen, Ellen K.
AU - Eisenga, Michele F.
AU - Vernooij, Robin W.M.
AU - van Jaarsveld, Brigit C.
AU - ter Braak, Nicole
AU - Krekels, Marielle
AU - Weenink, Anne G.
AU - Dekker-Jansen, Margriet M.G.
AU - Klaassen, Rob J.L.
AU - Luik, Antinus J.
AU - Van Craenenbroeck, Amaryllis H.
AU - François, Karlien
AU - Verhaar, Marianne C.
AU - Özyilmaz, Akin
AU - Franssen, Casper F.M.
AU - Mulder, Janneke
AU - Snoep, Jaap Jan D.
AU - Douma, Caroline E.
AU - Klein, H. H.T.Inge
AU - Binnenmars, S. Heleen
AU - Mui, Kwok Wai
AU - Bos, Willem J.W.
AU - van Kempen, Gijs
AU - Verhave, Jacobien C.
AU - Huisman, Sebastiaan J.
AU - van der Meijden, Wilbert A.G.
AU - Siegert, Carl E.H.
AU - de Fijter, Carola W.H.
AU - Penne, Erik L.
AU - Wijering, Renate M.J.
AU - Brink, Huguette S.
AU - Bierma, Louwine
AU - Adema, Aaltje Y.
AU - Bosma, Renate J.
AU - Beerenhout, Charles H.
AU - Kuijper, Arno
AU - Janssen, Wilbert M.T.
AU - Hemmelder, Marc H.
AU - Litjens, Elisabeth
AU - van Alphen, Arjan M.
AU - Rotmans, Joris I.
AU - Dekker, Friedo W.
AU - Hoorn, Ewout J.
AU - Severs, David
AU - Bunthof, Kim L.W.
AU - van der Net, Jeroen B.
N1 - Publisher Copyright:
© The Author(s) 2025.
PY - 2025/12/1
Y1 - 2025/12/1
N2 - Background: More liberal use of iron therapy is favored in dialysis patients based on lower erythropoietin need and clinical outcomes. However, it remains unclear whether higher iron stores are associated with better patient-reported outcomes. We assessed the longitudinal associations of ferritin and transferrin saturation (TSAT) levels with patient-reported outcomes in incident dialysis patients. Methods: This prospective cohort study included incident dialysis patients who had completed at least one patient-reported outcome questionnaire and had undergone a laboratory assessment (e.g., ferritin, transferrin saturation, hemoglobin) within the first year of dialysis. The primary outcome was health-related quality of life (HRQoL), measured using the 12-Item Short Form (SF-12) survey. Secondary outcomes were the presence of anemia-related symptoms, measured using the Dialysis Symptom Index. We used sequential conditional mean models to adjust for baseline and time-varying confounding. Results: We included 1069 incident dialysis patients, of whom 76% initiated hemodialysis. The mean (SD) age was 64.0 (14.2) years and 34% were female. Over a 1-year follow-up, patients with ferritin levels < 200, > 500 − 700, and > 700 ng/mL did not have a significantly different HRQoL compared to those with levels between 200 − 500 ng/mL, chosen as reference. Similarly, patients with TSAT levels < 20 or ≥ 40% did not have a significantly different HRQoL compared to those with levels between 20 − 39%. No significant differences were found in the odds of experiencing fatigue, shortness of breath, muscle cramps or restless legs between the ferritin and TSAT groups. Conclusion: Differences in iron status parameters were not associated with differences in patient-reported outcomes during the first year of dialysis. Our findings therefore suggest that decisions on iron therapy should be guided by target hemoglobin levels and clinical outcomes in dialysis patients.
AB - Background: More liberal use of iron therapy is favored in dialysis patients based on lower erythropoietin need and clinical outcomes. However, it remains unclear whether higher iron stores are associated with better patient-reported outcomes. We assessed the longitudinal associations of ferritin and transferrin saturation (TSAT) levels with patient-reported outcomes in incident dialysis patients. Methods: This prospective cohort study included incident dialysis patients who had completed at least one patient-reported outcome questionnaire and had undergone a laboratory assessment (e.g., ferritin, transferrin saturation, hemoglobin) within the first year of dialysis. The primary outcome was health-related quality of life (HRQoL), measured using the 12-Item Short Form (SF-12) survey. Secondary outcomes were the presence of anemia-related symptoms, measured using the Dialysis Symptom Index. We used sequential conditional mean models to adjust for baseline and time-varying confounding. Results: We included 1069 incident dialysis patients, of whom 76% initiated hemodialysis. The mean (SD) age was 64.0 (14.2) years and 34% were female. Over a 1-year follow-up, patients with ferritin levels < 200, > 500 − 700, and > 700 ng/mL did not have a significantly different HRQoL compared to those with levels between 200 − 500 ng/mL, chosen as reference. Similarly, patients with TSAT levels < 20 or ≥ 40% did not have a significantly different HRQoL compared to those with levels between 20 − 39%. No significant differences were found in the odds of experiencing fatigue, shortness of breath, muscle cramps or restless legs between the ferritin and TSAT groups. Conclusion: Differences in iron status parameters were not associated with differences in patient-reported outcomes during the first year of dialysis. Our findings therefore suggest that decisions on iron therapy should be guided by target hemoglobin levels and clinical outcomes in dialysis patients.
UR - https://www.scopus.com/pages/publications/105021943774
U2 - 10.1007/s40620-025-02363-w
DO - 10.1007/s40620-025-02363-w
M3 - Article
C2 - 41034675
AN - SCOPUS:105021943774
SN - 1121-8428
VL - 38
SP - 2641
EP - 2650
JO - Journal of Nephrology
JF - Journal of Nephrology
IS - 9
ER -