{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:08:37Z","timestamp":1787018917387,"version":"build-2736575974"},"reference-count":19,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:00:00Z","timestamp":1768867200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perit Dial Int"],"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Iron plays a critical role beyond erythropoiesis, yet the prognostic significance of iron deficiency (ID) independent of anemia remains poorly defined in the peritoneal dialysis (PD) population. This study aimed to evaluate the association between iron status, specifically transferrin saturation (TSAT), and mortality in PD patients, independent of hemoglobin levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting, participants, and measurements<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of 11,013 adults who initiated PD at a large US dialysis network between December 2004 and January 2011. Patients had at least 180 days on PD and baseline data on TSAT, ferritin, hemoglobin, albumin, and white blood cell count. The primary outcome was all-cause mortality. Broadly adjusted associations between iron parameters and mortality were assessed using Cox proportional hazards models and restricted cubic splines, with adjustments for demographic, clinical, treatment-related, and laboratory variables including hemoglobin and ESA use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Iron deficiency, defined as TSAT \u226420%, was present in 10% of patients at PD initiation. The cohort was 54% male and 70% Caucasian, with a mean age of 55 years; 39% had diabetes. While 91% received erythropoiesis-stimulating agents, only 34% received IV iron. After comprehensive adjustment, TSAT \u226420% remained independently associated with increased mortality (adjusted HR: 1.26; 95% CI: 1.12\u20131.42). Spline analyses showed a sharp rise in mortality risk at TSAT levels below 25%. Ferritin was inconsistently associated with mortality risk. During follow-up, 2704 deaths occurred (24.6% of the cohort) over a median 440-day follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Iron deficiency is common in incident PD patients and is associated with increased mortality risk, independent of anemia. These findings challenge current anemia-centric treatment paradigms and suggest that iron status, particularly TSAT, should be routinely assessed in PD patients regardless of hemoglobin levels. A prospective, randomized trial is warranted to evaluate whether proactive iron management improves outcomes in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08968608251412935","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T22:17:35Z","timestamp":1768947455000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Anemia-independent prognostic value of iron deficiency in incident peritoneal dialysis patients"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3960-9935","authenticated-orcid":false,"given":"Vladimir","family":"Rigodon","sequence":"first","affiliation":[{"name":"Renal Research Institute"},{"name":"Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murilo","family":"Guedes","sequence":"additional","affiliation":[{"name":"Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil"},{"name":"Stanford University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter G","family":"Pecoits","sequence":"additional","affiliation":[{"name":"Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil"},{"name":"Indiana University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brianna","family":"Hartley","sequence":"additional","affiliation":[{"name":"Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil"},{"name":"NSU Dr Kiren C. Patel College of Osteopathic Medicine, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Jiao","sequence":"additional","affiliation":[{"name":"Renal Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Len A","family":"Usvyat","sequence":"additional","affiliation":[{"name":"Renal Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinesh K","family":"Chatoth","sequence":"additional","affiliation":[{"name":"Fresenius Medical Care"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey L","family":"Hymes","sequence":"additional","affiliation":[{"name":"Fresenius Medical Care"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franklin W","family":"Maddux","sequence":"additional","affiliation":[{"name":"Fresenius Medical Care AG"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeroen","family":"Kooman","sequence":"additional","affiliation":[{"name":"Maastricht University Medical Center, Maastricht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thyago P","family":"Moraes","sequence":"additional","affiliation":[{"name":"Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochen G","family":"Raimann","sequence":"additional","affiliation":[{"name":"Fresenius Medical Care"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kotanko","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John W","family":"Larkin","sequence":"additional","affiliation":[{"name":"Renal Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Pecoits-Filho","sequence":"additional","affiliation":[{"name":"Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"On behalf of the MONDO Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,20]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2020101531"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2021.07.032"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.642296"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-05200-3"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.numecd.2020.12.018"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.3747\/pdi.2015.00218"},{"key":"e_1_3_2_8_2","first-page":"279","article-title":"KDIGO Clinical practice guideline for Anemia in chronic kidney disease","volume":"2","author":"Kidney Disease: Improving Global Outcomes (KDIGO) Anemia Work Group","year":"2012","unstructured":"Kidney Disease: Improving Global Outcomes (KDIGO) Anemia Work Group. KDIGO Clinical practice guideline for Anemia in chronic kidney disease. Kidney Inter., Suppl. 2012; 2: 279\u2013335.","journal-title":"Kidney Inter., Suppl."},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfad152"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfab050"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1797.2004.00261.x"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu385"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1159\/000493551"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12937-025-01072-1"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)02083-9"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2019020213"},{"key":"e_1_3_2_17_2","article-title":"Markers of iron Status in chronic kidney disease diagnosing iron deficiency","volume":"21","author":"Gaweda AE","unstructured":"Gaweda AE. Markers of iron Status in chronic kidney disease diagnosing iron deficiency. Hemodial Int 2017 Jun; 21: S21\u2013S27.","journal-title":"Hemodial Int"},{"key":"e_1_3_2_18_2","article-title":"The fascinating but deceptive ferritin: to measure it or not to measure it in chronic kidney disease?","volume":"1","author":"Kalantar-Zadeh K","unstructured":"Kalantar-Zadeh K, Kalantar-Zadeh K, Lee GH. The fascinating but deceptive ferritin: to measure it or not to measure it in chronic kidney disease? Clin J Am Soc Nephrol 2006 Sep; 1: S9.","journal-title":"Clin J Am Soc Nephrol"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-75435-5"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.7861\/clinmed.2020-0582"}],"container-title":["Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08968608251412935","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/08968608251412935","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08968608251412935","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T22:39:07Z","timestamp":1777675147000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/08968608251412935"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,20]]},"references-count":19,"alternative-id":["10.1177\/08968608251412935"],"URL":"https:\/\/doi.org\/10.1177\/08968608251412935","relation":{},"ISSN":["0896-8608","1718-4304"],"issn-type":[{"value":"0896-8608","type":"print"},{"value":"1718-4304","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,20]]},"article-number":"08968608251412935"}}