Differential Associations of Iron Deficiency with Renal Progression and Mortality in Anemic…

Cohort studyKidney diseases (Basel, Switzerland)· Jan 2026

Differential Associations of Iron Deficiency with Renal Progression and Mortality in Anemic Non-Dialysis-Dependent Chronic Kidney Disease.

Wen-Cong Guo, Li-Cong Su, Bin Wang … CRDS study Investigators

NephrologyCohort studyPrognosisQ1IF 3.7

Low transferrin saturation linked to higher mortality risk in anemic chronic kidney disease

Differential Associations of Iron Deficiency with Renal Progression and Mortality in Anemic Non-Dialysis-Dependent Chronic Kidney Disease.

Wen-Cong Guo … CRDS study Investigators

Kidney diseases (Basel, Switzerland) · Jan 2026

Background

Iron deficiency is prevalent in chronic kidney disease (chronic kidney disease), particularly among patients with anemia.

Methods

We conducted a multicenter retrospective cohort study using data from the China Renal Data System.

n = 40,667 patients

Results

Transferrin saturation of 20% or less associated with about 19% higher risk of death

aHR 1.19 (95% CI 1.06 to 1.36)

CI excludes the null - significant

More results

Of these, 11,116 (29.02%) had ferritin ≤100 ng/mL and 3,295 (35.78%) had transferrin saturation ≤20%.

During follow-up, chronic kidney disease progression occurred in 8,756 (22.86%) patients in the ferritin cohort and 2,459 (26.70%) in the transferrin saturation cohort.

More results

In multivariable analyses, ferritin ≤100 ng/mL was associated with a modestly lower risk of chronic kidney disease progression than levels greater than 100 ng/mL (adjusted hazard ratio [aHR], 0.95; 95% confidence interval [CI], 0.90-0.99), with similar results in competing risk analyses.

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Conclusion · 1 of 3

In Chinese adults with anemia and NDD-chronic kidney disease, ferritin and transferrin saturation showed divergent prognostic associations.

Conclusion · 2 of 3

transferrin saturation ≤20% identified higher mortality risk, whereas ferritin ≤100 ng/mL was associated with a modestly lower observed risk of chronic kidney disease progression in an inflammation-dependent pattern.

Conclusion · 3 of 3

These findings support routine, context-aware assessment of iron indices, particularly transferrin saturation, in anemic NDD-chronic kidney disease.

Differential Associations of Iron Deficiency with Renal Progression and Mortality in Anemic Non-Dialysis-Dependent Chronic Kidney Disease.

Differential Associations of Iron Deficiency with Renal Progression and Mortality in Anemic Non-Dialysis-Dependent Chronic Kidney Disease.

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