%0 Journal Article
%T The Relationship of Initial Transferrin Saturation to Cardiovascular Parameters and Outcomes in Patients Initiating Dialysis
%A Hyang Mo Koo
%A Chan Ho Kim
%A Fa Mee Doh
%A Mi Jung Lee
%A Eun Jin Kim
%A Jae Hyun Han
%A Ji Suk Han
%A Hyung Jung Oh
%A Jung Tak Park
%A Seung Hyeok Han
%A Tae-Hyun Yoo
%A Shin-Wook Kang
%J PLOS ONE
%D 2014
%I Public Library of Science (PLoS)
%R 10.1371/journal.pone.0087231
%X 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 ¡Ü20%, 20¨C40%, 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 ¡Ü20% compared to those with TSAT 20¨C40% (reference group). Cox regression analysis revealed that patients with TSAT ¡Ü20% 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 ¡Ü20% was significantly associated with left ventricular hypertrophy [odds ratio (OR) = 1.46], high-sensitivity C-reactive protein ¡Ý3 mg/dL (OR = 2.09), N-terminal pro B-type natriuretic peptide ¡Ý10000 pg/mL (OR = 2.04), and troponin-T¡Ý0.1 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.
%U http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0087231