Narrow Transferrin Saturation and Ferritin Ranges Predict Optimal Hemoglobin Response to IV Iron in Patients with Nondialysis-Dependent CKD

Le résumé fourni par la source

Background: Anemia is a common complication of non-dialysis-dependent chronic kidney disease (NDD-CKD), often driven by inflammation and disrupted iron metabolism, but also associated with absolute deficiency. While transferrin saturation (TSAT) and ferritin guide treatment, they may not reliably reflect anemia mechanisms or predict outcomes. Methods: We analyzed 703 German patients with NDD-CKD from CKDopps treated with IV iron without recent erythropoiesis-stimulating agent (ESA) use. Hemoglobin (Hb) response was modeled using spline regressions with TSAT-ferritin interactions. Contour plots illustrated Hb response patterns across biomarker levels. Results: Mean age was 73 years; 51% were male; 46% had diabetes, 29% coronary artery disease. Hb response to IV iron varied nonlinearly with baseline TSAT and ferritin. Patients with TSAT <10% and ferritin <50 ng/mL showed the most consistent Hb gains. Higher levels of iron biomarkers were linked to reduced or absent response (orange and red in the figure), likely due to inflammation, marrow suppression, or hormonal deficiency. Contour plots identified a narrow TSAT-ferritin window (green and yellow in the figure) associated with optimal response. Conclusion: TSAT and ferritin predict Hb response to IV iron in NDD-CKD, but efficacy appears limited to a narrower range (TSAT <10%, ferritin<75ng/ml) than current guidelines suggest. These results underscore the need for more individualized, physiology-based anemia management. Funding: Commercial Support - Disc Medicine

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.