This prospective, observational study was conducted in two affiliated hospitals (Kaohsiung Medical University Hospital and Kaohsiung Municipal Hsiao-Kang Hospital) of Kaohsiung Medical University in southern Taiwan. Totally, 3749 patients who joined the Integrated CKD Care Program Kaohsiung for Delaying Dialysis from 11 November, 2002 to 31 May, 2009 were included. CKD was staged according to the definition of K/DOQI guidelines24, and the estimated glomerular filtration rate (eGFR) was calculated using the equation of the 4-variable Modification of Diet in Renal Disease (MDRD) study. We excluded patients suffering from CKD stage 5 or those who were lost to follow-up in less than three months; therefore, the final study population was composed of 2500 CKD stage 1–4 patients. All participants in our study provided informed consent to participate. The protocol in the study was approved the Institutional Review Board of Kaohsiung Medical University Hospital. We performed the methods according to the approved guidelines.

To study the impact of TSAT and iron on anemia at baseline, we divided these 2500 CKD patients into four groups—“normal TSAT normal iron”, “normal TSAT low iron”, “low TSAT normal iron”, and “low TSAT low iron”. The cutoff value of TSAT was 20%, while the cutoff values of serum iron were 70 μg/dL in men and 60 μg/dL in women. To study the impact of TSAT and iron level on anemia after 1 year of follow-up, we retrospectively selected 1621 patients without anemia (Hb ≧ 11 g/dL) at baseline, after excluding patients with dialysis, mortality, loss of follow-up, and < 3 hemoglobin measurements in 1 year.

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