Variations in iron profile among dialysis adherent chronic kidney disease patients and compare with the non-adherence chronic kidney disease patients

Background: Chronic kidney disease (CKD) constitutes one of the most important global health challenges and iron deficiency (ID) anemia are both frequent complications, especially in patients on dialysis. Dialysis treatment is an important aspect of addressing these complications, yet the treatment adherence rate is low in CKD patients and the association between dialysis adherence and differences in iron profiles among CKD patients is unclear. Objectives: This study aimed to assess differences in iron profile in dialysis-adherent and non-adherent chronic kidney disease subjects and analyze the profiles between both groups. Methods: One hundred twenty patients undergoing hemodialysis were included in this cross-sectional study, divided into two groups based on two subcategories of dialysis adherence- adherent (n=60) and nonadherent (n=60). The parameters of iron profile-also defined as serum ferritin, transferrin saturation (TSAT), hemoglobin, and serum iron-were studied. Further, multivariate regression analysis was carried out, adjusting possible confounders such as age, sex, diabetes, and duration of dialysis. Results: Serum ferritin was significantly higher among patients in the adherent group when compared with those in the non-adherent group (235.6 120.2 ng/mL vs. 185.2 105.3 ng/mL; p=0.03), TSAT (33.4 9.3% vs. 28.8 10.2%; p=0.02), and hemoglobin level (11.5 1.8 g/dL vs. 10.2 2.1 g/dL; p=0.04). That is, non-adherence to the therapy was associated with a significantly higher number of patients having iron deficiency anemia (63% in non-adherent vs. 40% in adherent patients; p=0.01). Multivariate analysis confirmed that dialysis adherence was independently associated with better iron status (p<0.05 for all parameters). Conclusion: In hemodialysis patients, adherence to dialysis presents as a strong predictor of better iron profile. More "iron parameters" were better and showed a decreased reliance on iron deficiency anemia for adherents. Such improvement, however, may significantly reduce anemia-associated complications through strategies that improve adherence to dialysis treatment by optimizing iron metabolism among chronic kidney disease patients.