Dataset Information

Serum biomarkers of iron stores are associated with worse physical health-related quality of life (HRQoL) in non-dialysis dependent chronic kidney disease (NDD-CKD) patients with or without anemia.

ABSTRACT:

Background

Iron deficiency (ID) is a common condition in non-dialysis dependent chronic kidney disease (NDD-CKD) patients that is associated with poorer clinical outcomes. However, the effect of ID on health-related quality of life (HRQoL) in this population is unknown. We analyzed data from a multinational cohort of NDD-CKD stage 3 to 5 patients to test the association between transferrin saturation index (TSAT) and ferritin with HRQoL.

Methods

Patients from Brazil (N = 205), France (N = 2015), and the US (N = 293) in the CKD Outcomes and Practice Patterns Study (CKDopps, 2013 to 2019) were included. We evaluated the association of TSAT and ferritin (and functional and absolute ID, defined as TSAT ≤ 20% and ferritin >300 or < 50 ng/mL, respectively) on pre-specified HRQoL measures, including KDQOL-36 PCS and MCS as the primary outcomes. Models were adjusted for confounders including hemoglobin (Hgb).

Results

TSAT ≤15% and both ferritin <50 ng/mL and ≥300 ng/mL were associated with worse PCS scores, but not with MCS. Patients with composite TSAT ≤20% and ferritin <50 or ≥ 300 ng/mL had lower functional status and worse PCS than those with TSAT of 20%-30% and ferritin 50-299 ng/mL. Patients with lower TSAT were less likely to perform intense physical activity. Adjustment for Hgb only slightly attenuated the observed effects.

Conclusions

Low TSAT levels, as well as both low TSAT with lower ferritin and low TSAT with high ferritin, are associated with worse physical HRQoL in NDD-CKD patients, even after accounting for Hgb level. Interventional studies of iron therapy on HRQoL among NDD-CKD individuals are needed to confirm these findings.

SUBMITTER: Guedes M

PROVIDER: S-EPMC8396397 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundWHO guidelines recommend concurrent iron and antimalarial treatment in children with malaria and iron deficiency, but iron may not be well absorbed or utilized during a malaria episode.ObjectivesWe aimed to determine whether starting iron 28 d after antimalarial treatment in children with severe malaria and iron deficiency would improve iron status and lower malaria risk.MethodsWe conducted a randomized clinical trial on the effect of immediate compared with delayed iron treatment in Ugandan children 18 mo-5 y of age with 2 forms of severe malaria: cerebral malaria (CM; n = 79) or severe malarial anemia (SMA; n = 77). Asymptomatic community children (CC; n = 83) were enrolled as a comparison group. Children with iron deficiency, defined as zinc protoporphyrin (ZPP) ≥ 80 µmol/mol heme, were randomly assigned to receive a 3-mo course of daily oral ferrous sulfate (2 mg · kg-1 · d-1) either concurrently with antimalarial treatment (immediate arm) or 28 d after receiving antimalarial treatment (delayed arm). Children were followed for 12 mo.ResultsAll children with CM or SMA, and 35 (42.2%) CC, were iron-deficient and were randomly assigned to immediate or delayed iron treatment. Immediate compared with delayed iron had no effect in any of the 3 study groups on the primary study outcomes (hemoglobin concentration and prevalence of ZPP ≥ 80 µmol/mol heme at 6 mo, malaria incidence over 12 mo). However, after 12 mo, children with SMA in the delayed compared with the immediate arm had a lower prevalence of iron deficiency defined by ZPP (29.4% compared with 65.6%, P = 0.006), a lower mean concentration of soluble transferrin receptor (6.1 compared with 7.8 mg/L, P = 0.03), and showed a trend toward fewer episodes of severe malaria (incidence rate ratio: 0.39; 95% CI: 0.14, 1.12).ConclusionsIn children with SMA, delayed iron treatment did not increase hemoglobin concentration, but did improve long-term iron status over 12 mo without affecting malaria incidence.This trial was registered at clinicaltrials.gov as NCT01093989.