Associations Among Serum Transferrin Levels, Markers of Malnutrition, and Mortality in Hemodialysis Patients

ABSTRACT Introduction A serum transferrin (transferrin) level below 200 mg/dL has been suggested as an indicator of malnutrition in hemodialysis (HD) patients. We investigated the relationships among transferrin levels, various markers of malnutrition, and 1‐year mortality in this patient population. Methods We assessed transferrin, ferritin, and transferrin saturation (TSAT) five times over 1 year. We also measured baseline serum albumin, C‐reactive protein (CRP), geriatric nutritional risk index (GNRI), Kt/Vurea, post‐dialysis body composition (using bioimpedance analysis), and 1‐year mortality. Findings Our study included 431 HD patients (mean age: 67 ± 11 years; median dialysis duration: 67 [35–138] months; diabetes prevalence: 45%). Patients with baseline transferrin ≥ 200 mg/dL had consistently and significantly higher transferrin concentrations throughout the study ( p < 0.001). Compared to patients with baseline transferrin < 200 mg/dL ( n = 285), those with baseline transferrin ≥ 200 mg/dL ( n = 146) showed significantly higher serum albumin (3.7 [3.4–3.9] vs. 3.4 [3.1–3.7] g/dL), GNRI (95 [90–98] vs. 90 [85–95]), and lean tissue index (11.2 [9.5–13.3] vs. 10.3 [9.0–12.1] kg/m 2 ). Conversely, they had significantly lower TSAT (22% ± 12% vs. 27% ± 14%), ferritin (74 ± 79 vs. 172 ± 148 ng/mL), and CRP ( p < 0.01 for all). Baseline serum albumin, Kt/Vurea, and the presence of diabetes were significant determinants of having a baseline transferrin level ≥ 200 mg/dL ( p < 0.05). Over the 1‐year period, 45 all‐cause deaths occurred among the 431 patients. Patients with baseline transferrin ≥ 200 mg/dL had a significantly higher cumulative 1‐year survival rate ( p < 0.05). Furthermore, baseline transferrin was a significant predictor of 1‐year all‐cause mortality in HD patients (hazard ratio: 0.99; p < 0.05). Discussion Our findings indicate that HD patients with baseline transferrin ≥ 200 mg/dL exhibit a better nutritional status than those with transferrin < 200 mg/dL. Moreover, baseline transferrin serves as a significant predictor for 1‐year mortality in HD patients.