Association of Abnormal Iron Status with the Occurrence and Prognosis of Peritoneal Dialysis-Related Peritonitis: A Longitudinal Data-Based 10-Year Retrospective Study

Abstract

This retrospective study investigated the effect of iron status on peritonitis by analyzing longitudinal iron parameters in peritoneal dialysis (PD) patients. Patients who received PD at our center from 1 January 2006 to 31 December 2015 were included and followed up until 31 December 2017. According to the joint quartiles of baseline transferrin saturation and ferritin, iron status was categorized as reference iron status (RIS), absolute iron deficiency (AID), functional iron deficiency (FID), and high iron status (HIS). Generalized estimating equations and Cox regression models with time-dependent covariates were used. A total of 1258 PD patients were included; 752 (59.8%) were male, with a mean (±standard deviation) age of 47.4 (±14.9) years. During a median follow-up period of 35.5 (interquartile range, 18.4–60.0) months, 450 (34.3%) patients had 650 episodes of peritonitis. By analyzing longitudinal data, patients with AID were independently positively associated with the occurrence (adjusted odds ratio (AOR) = 1.45) and treatment failure of peritonitis (adjusted hazard ratio (AHR) = 1.85). Patients with HIS were positively associated with the treatment failure of peritonitis (AHR = 2.70). Longitudinal AID and HIS were associated with the episodes and poor prognosis of peritonitis. Active clinical monitoring and correction of iron imbalance in patients with PD are needed.

Iron status and anemia control are related to peritoneal membrane properties in peritoneally dialyzed patients

“…At least in part, this may be due to the fact that current analysis excluded patients with conditions that may have at least potentially contributed to absolute or functional iron deficiency. Fourteen percent of patients in our cohort had high iron status, comparable to other reports (6,8). These patients tended to have the lowest Hb level despite the highest median CERA dose, and worse preserved RRF.…”

“…Only 9% patients met the criteria for absolute iron deficiency, while none had functional iron deficiency. Our results stand out significantly from the literature data according to which iron deficiency prevalence exceeds 26% (6,8,16). At least in part, this may be due to the fact that current analysis excluded patients with conditions that may have at least potentially contributed to absolute or functional iron deficiency.…”

“…Abnormal iron status is associated with increased risk of all-cause and cardiovascular mortality (5,6). Furthermore, it is a factor in terms of both risk and prognosis for PD-related infectious complications (7,8).…”

Benefits and risks of essential trace elements in chronic kidney disease: a narrative review

“…A large US cohort study (N=22,820) showed an increased risk of infection-related events and infection-related mortality with high IV doses of Fe in HD ( 26 ), and a meta-analysis by Litton suggested IV Fe was associated with a significantly higher incidence of infection compared with either oral Fe or no Fe supplementation ( 27 ). A retrospective study analyzed the longitudinal Fe parameters of peritoneal dialysis (PD) patients and proposed Fe excess was associated with the onset of peritonitis and poor prognosis ( 28 ). There are also recent conflicting reports of randomized controlled trials concerning the association between IV Fe administration and infections.…”

Glycosylation and Characterization of Human Transferrin in an End-Stage Kidney Disease

“…Before starting the prescription of ESAs according to KDIQO recommendations, it is necessary to rule out acute inflammation, regulate secondary hyperparathyroidism (SHPT) and replace iron depots [23,24], which was carried out in our cohort. The assessment of feremia in PD patients is performed on the basis of serum Fe, TIBC and ferritin [25]. Substitution was carried out by administering heme and nonheme Fe orally, considering that PD is a form of home treatment [24,25].…”