The Prevalence of Functional Iron Deficiency and Its Impact on Mortality in Hemodialysis Patients

Background Chronic kidney disease (CKD) is a major public health concern that has become an epidemic both globally and in our country. Iron deficiency (ID) and functional iron deficiency (FID) are common among CKD patients. This study aimed to investigate the prevalence of FID and its impact on mortality in hemodialysis (HD) patients. Methods A retrospective study was conducted between 2010 and 2024 in patients undergoing HD in our hospital. Patients who had been on HD for at least three months were included in the study. Exclusion criteria included peritoneal dialysis, home hemodialysis, and age under 18 years. Results The study included 3,023 HD patients (mean age 64.50 ± 13.41 years; 57.6% male). The prevalence of FID was 14.7%, while absolute iron deficiency (AID) was 4.1%. Mortality was significantly higher in patients with FID compared to other groups (p < 0.05). The overall survival was 97% at 3 months, 87% at 12 months, 44% at 60 months in patients with FID. When we investigated the replated factors with mortality in patients with FID, we found that older age (B:1.012, 95%CI: [1.002–1.021]; p = 0.014) and hematocrit level (B:0.974, 95%CI: [0.954–0.995]; p = 0.014) were the independent factors related to mortality in patients with FID. Conclusions The prevalence of FID was determined to be 14.1% in our study. Mortality was significantly higher in the FID group compared to other groups. Age and hematocrit level were the independent factors related to mortality in patients with FID.