---
title: "Time-dependent associations between iron and mortality in…"
description: "Maintaining specific iron levels and administering moderate intravenous iron doses may improve survival in hemodialysis patients, but high ferritin…"
url: "https://magellanlongevity.com/study/d16033854.md"
canonical: "https://magellanlongevity.com/study/d16033854.html"
html: "https://magellanlongevity.com/study/d16033854.html"
type: "study"
study_key: "d16033854"
journal: "J Am Soc Nephrol"
year: 2005
pmid: "16033854"
doi: "10.1681/ASN.2005040423"
citations: 1
updated: 2026-09-02
author: "Gabriel Radu, DO"
author_credentials: "Physiatrist (PM&R). NY medical license 275110. NPI 1376861765."
publisher: "Magellan Longevity"
content_format: "markdown"
---

# Time-dependent associations between iron and mortality in hemodialysis patients

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## Citation

| Field | Value |
| --- | --- |
| Journal | J Am Soc Nephrol |
| Year | 2005 |
| PMID | [16033854](https://pubmed.ncbi.nlm.nih.gov/16033854/) |
| DOI | [10.1681/ASN.2005040423](https://doi.org/10.1681/ASN.2005040423) |
| Study key | d16033854 |

## Takeaway

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?

## Hypothesis

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).

## Methods

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.

## Results

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.

## Conclusion

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.

## Verbatim from the abstract

> serum ferritin levels between 200 and 1200 ng/ml associated with the lowest all-cause and cardiovascular death risks

## Where this study is used on Magellan

This paper is one of the citations behind the evidence grade on the pages below. Grades are assigned from the published research and are independent of affiliate commissions.

| Compound or device | Evidence grade | Graded pages |
| --- | --- | --- |
| Ferritin / Iron-Status Test | Measurement tool | [Ferritin / Iron-Status Test](https://magellanlongevity.com/p/147.md) |

## Reference

1. **Time-dependent associations between iron and mortality in hemodialysis patients**
   J Am Soc Nephrol 2005 · [PMID 16033854](https://pubmed.ncbi.nlm.nih.gov/16033854/) · [DOI 10.1681/ASN.2005040423](https://doi.org/10.1681/ASN.2005040423)

   > serum ferritin levels between 200 and 1200 ng/ml associated with the lowest all-cause and cardiovascular death risks

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## Related on Magellan Longevity

- [Ferritin / Iron-Status Test](https://magellanlongevity.com/p/147.md) — product graded on this and related evidence
- [Evidence: Serum ferritin (iron stores)](https://magellanlongevity.com/study/s147.md)
- [Longevity research map](https://magellanlongevity.com/longevity-research-map.html)
- [Evidence-based longevity supplements](https://magellanlongevity.com/longevity-supplements.md)

## Scope and disclosures

Educational information, not medical advice. Nothing here is intended to diagnose, treat, cure, or prevent any disease. Talk to your physician before starting any supplement or device, especially if you are pregnant, nursing, or taking medication.

Editorial firewall: evidence grades are assigned from the published research and are independent of any affiliate commission. As an Amazon Associate, Magellan Longevity earns from qualifying purchases.

Reviewed for accuracy by a board-certified physician (DO).