Association between hemoglobin variability, serum ferritin levels, and adverse events/mortality in maintenance hemodialysis patients

Takahiro Kuragano, Osamu Matsumura, Akihiko Matsuda, Taiga Hara, Hideyasu Kiyomoto, Toshiaki Murata, Kenichiro Kitamura, Shouichi Fujimoto, Hiroki Hase, Nobuhiko Joki, Atushi Fukatsu, Toru Inoue, Ikuhiro Itakura, Takeshi Nakanishi

Research output: Contribution to journalArticlepeer-review

116 Citations (Scopus)


In recent times, therapy for renal anemia has changed dramatically in that iron administration has increased and doses of erythropoiesis-stimulating agents (ESAs) have decreased. Here we used a prospective, observational, multicenter design and measured the serum ferritin and hemoglobin levels every 3 months for 2 years in 1086 patients on maintenance hemodialysis therapy. The associations of adverse events with fluctuations in ferritin and hemoglobin levels and ESA and iron doses were measured using a Cox proportional hazards model for time-dependent variables. The risks of cerebrovascular and cardiovascular disease (CCVD), infection, and hospitalization were higher among patients who failed to maintain a target-range hemoglobin level and who exhibited high-amplitude fluctuations in hemoglobin compared with patients who maintained a target-range hemoglobin level. Patients with a higher compared with a lower ferritin level had an elevated risk of CCVD and infectious disease. Moreover, the risk of death was significantly higher among patients with high-amplitude ferritin fluctuations compared with those with a low ferritin level. The risks of CCVD, infection, and hospitalization were significantly higher among patients who were treated with high weekly doses of intravenous iron compared with no intravenous iron. Thus, there is a high risk of death and/or adverse events in patients with hemoglobin levels outside the target range, in those with high-amplitude hemoglobin fluctuations, in those with consistently high serum ferritin levels, and in those with high-amplitude ferritin fluctuations.

Original languageEnglish
Pages (from-to)845-854
Number of pages10
JournalKidney international
Issue number4
Publication statusPublished - 2014 Jan 1


  • anemia
  • cardiovascular events
  • hemodialysis

ASJC Scopus subject areas

  • Nephrology


Dive into the research topics of 'Association between hemoglobin variability, serum ferritin levels, and adverse events/mortality in maintenance hemodialysis patients'. Together they form a unique fingerprint.

Cite this