What is the independent association between iron indices or administered intravenous iron and survival in maintenance hemodialysis (MHD) patients, considering their time-varying nature?
Ferritin / Iron-Status Test (J Am Soc Nephrol 2005, PMID 16033854) — optimal ranges for serum ferritin (200-1200 ng/ml), serum iron (60-120 microg/ml), and iron saturation ratio (30-50%) are associated with the lowest mortality risks in MHD patients. The study design cannot definitively determine if the observed associations between moderate doses of intravenous iron and improved survival are causal or due to selection bias by indication.
Source: J Am Soc Nephrol 2005, PMID 16033854 ↗ · Research map · How Magellan grades evidence · evidence confidence: high
J Am Soc Nephrol · 2005 · PMID 16033854 · DOI 10.1681/ASN.2005040423
Maintaining specific iron levels and administering moderate intravenous iron doses may improve survival in hemodialysis patients, but high ferritin levels are often confounded by malnutrition-inflammation.
The question
What is the independent association between iron indices or administered intravenous iron and survival in maintenance hemodialysis (MHD) patients, considering their time-varying nature?
What they tested
The associations between moderately high levels of serum ferritin, iron, iron saturation ratio, or administered intravenous iron and all-cause and cardiovascular death in MHD patients are confounded by the time-varying effects of malnutrition-inflammation-cachexia syndrome (MICS).
How they did it
Time-dependent Cox regression models were used to analyze prospectively collected data from a 2-year historical cohort (July 2001 to June 2003) of 58,058 MHD patients from DaVita dialysis clinics in the United States. Adjustments were made for case mix, administered intravenous iron and erythropoietin doses, and surrogates of MICS.
What they found
Serum ferritin levels between 200 and 1200 ng/ml, serum iron levels between 60 and 120 microg/ml, and iron saturation ratio between 30 and 50% were associated with the lowest all-cause and cardiovascular death risks. Administered intravenous iron up to 400 mg/mo was associated with improved survival, while doses >400 mg/mo tended to be associated with higher death rates. The association between serum ferritin levels >800 ng/ml and mortality appeared to be mostly due to MICS confounding.
What it means
Optimal ranges for serum ferritin (200-1200 ng/ml), serum iron (60-120 microg/ml), and iron saturation ratio (30-50%) are associated with the lowest mortality risks in MHD patients. Intravenous iron doses up to 400 mg/mo are linked to improved survival, but higher doses may increase death rates. The link between high ferritin (>800 ng/ml) and mortality is largely explained by MICS.
Limitations
The study design cannot definitively determine if the observed associations between moderate doses of intravenous iron and improved survival are causal or due to selection bias by indication. Clinical trials are needed to clarify this.
The paper at a glance
| Title | Time-dependent associations between iron and mortality in hemodialysis patients |
|---|---|
| Journal | J Am Soc Nephrol |
| Year | 2005 |
| PMID | 16033854 ↗ |
| DOI | 10.1681/ASN.2005040423 ↗ |
| Topic | General aging biology & healthspan |
Read the source: PubMed record (authors, abstract, full citation) ↗ · Publisher via doi.org ↗
Where Magellan uses this paper
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Ferritin / Iron-Status Test
Iron status has a U-shaped relationship with health: iron deficiency (low ferritin) is a leading cause of anemia and, even without anemia, is associated with fatigue that iron repletion can improve, while in older adults it has been linked to more severe infections;
Ferritin is the body's main intracellular iron-storage protein, and the concentration of ferritin…
Research describes the compound or intervention studied. It is not a claim about any specific product.
Cite this page
These citations point at this summary. To cite the original paper with its full author list, use the PubMed record or doi.org.
Magellan Longevity. (2026). What is the independent association between iron indices or administered intravenous iron and survival in maintenance hemodialysis (MHD) patients, considering their time-varying nature? [Plain-English summary of J Am Soc Nephrol 2005, PMID 16033854, DOI 10.1681/ASN.2005040423]. Magellan Longevity. https://magellanlongevity.com/study/d16033854.html@misc{magellan_d16033854,
title = {What is the independent association between iron indices or administered intravenous iron and survival in maintenance hemodialysis (MHD) patients, considering their time-varying nature?},
author = {{Magellan Longevity}},
year = {2026},
howpublished = {\url{https://magellanlongevity.com/study/d16033854.html}},
note = {Plain-English summary of PubMed PMID 16033854; DOI 10.1681/ASN.2005040423; J Am Soc Nephrol 2005. Reviewed by Gabriel Radu, DO},
urldate = {2026-08-11}
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