FP653EXPLORING THE ASSOCIATION BETWEEN FERRITIN LEVELS AND MORTALITY IN THE UK HAEMODIALYSIS POPULATION

Abstract

Introduction and Aims: Intravenous (IV) iron facilitates maintenance of target haemoglobin levels and improves anaemia management with lowering of ESA requirements in haemodialysis (HD) patients. Most UK centres use serum ferritin to evaluate iron status and to guide dosing. The 2014 UK Renal Registry report shows that twenty centres had greater than 20% (20‐60%) of their HD patients with ferritin ≥800 mg/L. The aim of the study was to explore in the UK haemodialysis population, risks linked to achieving higher ferritin levels as a consequence of iron dosing having adjusted for other acute phase proteins. Methods: All prevalent haemodialysis patients submitted to UK Renal Registry (UKRR) in England, Wales or Northern Ireland on 31st December 2011 were included. Patients were stratified into 4 groups by ferritin levels ≤ 200, 201 to ≤ 500, 501 to < 800, ≥ 800 micro g/L in keeping with the Renal Association recommendations. Oneand two‐year survival was assessed in the groups with Cox models used to sequentially adjust for clinical and laboratory covariates (Model 1: unadjusted; Model 2: age & sex; Model 3: Haemoglobin (12g/dl), ESA dose (<150 & ≥150 IU/Kg/week); Model 4: time on dialysis, URR (<65 & ≥65) & albumin) that could confound the association between ferritin and all‐cause mortality. Results: The analysis included 5,971 patients from 28 centres for haemodialysis (HD) which equated to 26% of the prevalent HD patients in the UK. HD patients in the highest ferritin group (≥800 micro g/L) had significantly worse outcomes with one‐ and two‐year mortality of 21% and 35%, respectively, compared to 15% and 28%, respectively, for patients in the reference group (201 to ≤ 500 micro g/L). Conclusions: Despite controlling for acute phase proteins such as albumin, high ferritin was associated with increased mortality risk suggesting either residual confounding or deleterious effect of excess iron dosing. Using causal models with adjustments made for IV iron doses may be better suited to explore this association further. PIVOTAL, a large UK randomised control trial, will hopefully also be able to better inform the renal community on long‐term safety of IV iron in this patient population. (Table Presented).