{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:46:49Z","timestamp":1785775609326,"version":"3.56.0"},"reference-count":40,"publisher":"S. Karger AG","issue":"1","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Kidney Dis"],"abstract":"<jats:p>Introduction: Iron deficiency is prevalent in chronic kidney disease (CKD), particularly among patients with anemia. However, the prognostic value of routinely measured iron biomarkers, ferritin and transferrin saturation (TSAT), in non-dialysis-dependent (NDD) CKD remains incompletely defined. Methods: We conducted a multicenter retrospective cohort study using data from the China Renal Data System. Eligible hospitalized adults had anemia and NDD-CKD with baseline serum ferritin or TSAT measurements. Iron deficiency was defined as ferritin \u2264100 ng\/mL and\/or TSAT \u226420%. The primary outcomes were CKD progression and all-cause mortality. Associations were assessed using multivariable Cox proportional hazards models; Fine and Gray competing risk models and prespecified subgroup analyses evaluated robustness. Results: Among 40,667 patients with anemic CKD, 38,307 had ferritin measurements, and 9,210 had TSAT measurements. Of these, 11,116 (29.02%) had ferritin \u2264100 ng\/mL and 3,295 (35.78%) had TSAT \u226420%. During follow-up, CKD progression occurred in 8,756 (22.86%) patients in the ferritin cohort and 2,459 (26.70%) in the TSAT cohort. In multivariable analyses, ferritin \u2264100 ng\/mL was associated with a modestly lower risk of CKD progression than levels greater than 100 ng\/mL (adjusted hazard ratio [aHR], 0.95; 95% confidence interval [CI], 0.90\u20130.99), with similar results in competing risk analyses. TSAT \u226420% was not associated with CKD progression (aHR, 1.04; 95% CI, 0.95\u20131.13). For all-cause mortality, ferritin \u2264100 ng\/mL was not independently associated with risk (aHR, 0.99; 95% CI, 0.93\u20131.06), whereas TSAT \u226420% was associated with higher risk (aHR, 1.19; 95% CI, 1.06\u20131.36). CRP-stratified analyses indicated that ferritin \u2264100 ng\/mL was associated with lower CKD progression risk only among patients with CRP \u226410 mg\/L, suggesting that the prognostic association of ferritin varied by inflammatory status. Conclusion: In Chinese adults with anemia and NDD-CKD, ferritin and TSAT showed divergent prognostic associations. TSAT \u226420% identified higher mortality risk, whereas ferritin \u2264100 ng\/mL was associated with a modestly lower observed risk of CKD progression in an inflammation-dependent pattern. These findings support routine, context-aware assessment of iron indices, particularly TSAT, in anemic NDD-CKD.<\/jats:p>","DOI":"10.1159\/000552972","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T16:01:16Z","timestamp":1781280076000},"page":"662-675","source":"Crossref","is-referenced-by-count":0,"title":["Differential Associations of Iron Deficiency with Renal Progression and Mortality in Anemic Non-Dialysis-Dependent Chronic Kidney Disease"],"prefix":"10.1159","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5190-9666","authenticated-orcid":false,"given":"Wen-Cong","family":"Guo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Cong","family":"Su","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1606-5004","authenticated-orcid":false,"given":"Bin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6694-8406","authenticated-orcid":false,"given":"Zuo-Lin","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng-Mei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7288-3020","authenticated-orcid":false,"given":"Yi","family":"Wen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng-Chun","family":"Gong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3117-7418","authenticated-orcid":false,"given":"Fan-Fan","family":"Hou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bi-Cheng","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on 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