Home Assessment of iron metabolism and iron deficiency in incident patients on incident continuous ambulatory peritoneal dialysis
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Assessment of iron metabolism and iron deficiency in incident patients on incident continuous ambulatory peritoneal dialysis

  • Qinghua Yin , Na Guo , Ping Fu and Hui Zhong EMAIL logo
Published/Copyright: September 17, 2024
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Open Medicine
From the journal Open Medicine Volume 19 Issue 1

Abstract

Objective

The aim of this study was to investigate iron status and iron deficiency in incident continuous ambulatory peritoneal dialysis (CAPD) patients and identify influencing factors.

Methods

Patients with end-stage renal disease were enrolled. Clinical data of iron metabolism and biochemical and dialysis parameters during the first peritoneal dialysis evaluation were collected. Serum ferritin (SF) and transferrin saturation (TSAT) levels were evaluated, and independent influencing factors were identified by correlation and regression analyses.

Results

Of 1,128 adult CAPD patients, 41.2% had iron deficiency (ID), 15.7% had absolute iron deficiency, and 8.2% had functional iron deficiency. The average SF level was (276.8 ± 277.9) μg/L, and iron saturation was (29.8 ± 12.7)%. Additionally, 50.2 and 69.3% of patients reached targets in SF level and iron saturation recommended by the Chinese Society of Nephrology. SF level and TSAT were not correlated with estimated glomerular filtration rate, whereas negatively correlated with platelet count and inflammatory factors. Low platelet count, presence of diabetes mellitus and high interleukin 6 levels were independent factors of lower TSAT.

Conclusions

ID is common in patients with CAPD. Women and those with thrombocytopenia, diabetes, and inflammation are at higher risk for iron storage or reduced iron utilization. In the initial CAPD stage, a reasonable iron supplement strategy may be established for CAPD patients with high-risk factors.

Keywords: peritoneal dialysis; serum ferritin; ferritin saturation; iron deficiency; inflammation

1 Introduction

Iron deficiency (ID) constantly occurs in dialysis patients. For these patients, iron intake is inadequate due to loss of appetite caused by uremia, dietary protein restriction, and drug side effects. These symptoms may be exacerbated by the presence of iron absorption and mobilization disorders [1]. The incidence of absolute iron deficiency (AID) and functional iron deficiency (FID) anemia is high in dialysis patients. Up to date, the management of anemia and iron status disturbances and outcomes in predialysis chronic kidney disease (CKD) and hemodialysis (HD) patients have been intensively studied. However, few studies analyzing the characteristics of anemia and iron metabolism in peritoneal dialysis (PD) patients have been conducted. Recent large-scale international study has demonstrated that more than half of PD patients have various degrees of anemia, and, regardless of iron supplementation, a certain percentage of them has disequilibrium of iron status [2]. Abnormal iron status is associated with an increased risk of all-cause and cardiovascular mortality. Furthermore, it is a factor in terms of both risk and prognosis for PD-related infectious complications [3,4]. In this study, clinical data of PD patients admitted to our hospital from 2011 to 2023 were retrospectively analyzed, and the indicators of iron metabolism and influencing factors in the early stages of ID were identified, aiming to provide a reference for developing anemia treatment strategies for patients with PD.

2 Subjects and methods

2.1 Inclusion and exclusion criteria

Patients who underwent PD catheterization for the first time in the Department of Nephrology, West China Hospital of Sichuan University, from January 2011 to June 2023 were recruited in this study. Inclusion criteria were as follows: (1) age >18 years and (2) the first follow-up assessment was performed 1–3 months after the start of PD. Exclusion criteria were as follows: (1) incomplete iron metabolism index data; (2) patients were undergoing HD simultaneously; and (3) patients receiving intravenous iron infusion or blood transfusion within 1 month.

2.2 Data collection

Clinical data were collected from the PD database for the initial evaluation of patients at 1–3 months after the initiation of their first PD. This initial evaluation included basic information, medications (oral iron, the use of erythropoiesis-stimulating agents [ESAs] and hypoxic inducible factor prolyl hydroxylase inhibitor – Roxadustat), iron metabolism index (serum ferritin [SF], serum iron, transferrin saturation [TSAT], and transferrin), hemoglobin, serum albumin, inflammation index (high-sensitivity C-reactive protein [hs-CRP], interleukin 6 [IL-6]), blood fat, parathyroid hormone (PTH), and electrolytes (blood calcium and phosphorus). Moreover, 24 h of PD fluid, 24 h of urine creatinine and urea concentration, 4 h of PD fluid creatinine concentration, and 24 h of urine volume and PD fluid in and out were collected to calculate dialyzing-related indexes. Body surface area (BSA) was calculated using the Gehan formula [5]. The assessment of PD included an estimate of glomerular filtration rate (eGFR) using an arithmetic mean of creatinine clearance and urea clearance. The weekly total urea clearance index (KT/V) and standardized protein nitrogen decomposition rate (nPCR) were calculated according to the adequacy guidelines recommended by the International Peritoneal Dialysis Association. The transport characteristics comprised 4-h PD and plasma creatinine ratio (D/P4h), calculated using Adequest 2.0, run by Baxter PD.

2.3 Definition

According to the “Chinese expert consensus on diagnosis and treatment for renal anemia (2018 revision)”, ID or relative ID was defined as SF < 100 μg/L or TSAT ≤ 20% [3]. AID was defined as SF < 100 μg/L and TSAT < 20% [4]. FID was defined as ferritin > 100 μg/L and TSAT < 20% [5,6]. SF was defined as 100 μg/L ≤ SF < 500 μg/L and TSAT attainment was defined as 20% ≤ TSAT < 50%, respectively.

2.4 Statistical analysis

All analyses were conducted with IBM SPSS Statistics version 20 (IBM Corp., NY, USA). At baseline, categorical data were compared using Chi-square test, and continuous variables were analyzed using an unpaired t-test or nonparametric Mann–Whitney U test. Data are presented as mean ± standard deviation and as median and range, where appropriate. Person correlation and Spearman correlation analyses were used for measurement data of normal distribution and non-normal distribution, respectively. Kendall correlation analysis was adopted for classification variables. Factors associated with iron metabolism (SF and TSAT) were screened by correlation analysis (inclusion criteria were <0.05). The screened correlation factors were taken as independent variables, and the independent influencing factors of SF and TSAT were analyzed by multivariate linear regression. P < 0.05 was considered statistically significant.

  1. Ethical approval: This study has been approved by the Ethics Committee of West China Hospital, Sichuan University (Grant No. 891, 2019).

  2. Informed consent: Informed written consent was obtained from the patients or their representatives.

3 Results

3.1 Baseline characteristics

A total of 1,187 eligible continuous ambulatory PD patients were eligible for the inclusion and exclusion criteria. Among them, 59 patients were excluded, including 50 (4.2%) with incomplete data, 5 (0.5%) with concurrent HD, and 4 (0.3%) with a history of intravenous iron infusion or/or blood transfusion within the last month. Finally, 1,128 eligible patients were enrolled. The mean age was (45.9 ± 14.0) years (18–91 years). A total of 739 cases (65.5%) were male, 881 patients (78.1%) received oral iron, 745 patients (66.0%) received erythropoietin, and 176 (15.6%) patients received Roxadustat (those initially received Roxadustat from January 2020 in our hospital). A total of 651 cases (57.7%) had hemoglobin levels of lower than 100 g/L. Clinical data of all patients are shown in Table 1. More women, lower BSA, and higher IL-6 levels were observed in the ID group than in the non-ID group.

Table 1

Comparison of baseline characteristics between the ID and non-ID groups

Index Total ID group, N = 456 Non-ID group, N = 672 P
Male (%) 739 (65.5%) 48.0% 68.75% <0.001
Age (years) 45.66 (21.78) 45.22 (18.72) 44.81 (21.74) 0.39
BSA (m2) 1.66 ± 0.17 1.63 ± 0.17 1.67 ± 0.17 0.005
DM (%) 180 (16.0%) 17.30% 14.10% 0.149
Albumin (g/L) 35.42 ± 4.39 35.02 ± 4.92 34.88 ± 5.02 0.116
Prealbumin (g/L) 348.59 ± 85.09 342.75 ± 82.05 353.01 ± 87.06 0.115
Urea (mmol/L) 19.77 (7.453) 19.7 (7.34) 18.95 (7.50) 0.338
Creatinine (μmol/L) 694.45 (308.25) 716 (253.7) 731.35 (313) 0.3.3
Uric acid (μmol/L) 416.05 ± 85.50 418.01 ± 82.87 415.83 ± 89.34 0.659
Triglyceride (mmol/L) 1.33 (0.76) 1.32 (0.75) 1.36 (0.86) 0.139
Cholesterol (mmol/L) 4.45 (1.09) 4.56 (1.31) 4.43 (1.21) 0.213
Ca (mmol/L) 2.13 ± 0.22 2.13 ± 0.20 2.14 ± 0.23 0.741
P (mmol/L) 1.38 (0.49) 1.42 (0.51) 1.36 (0.54) 0.103
PTH (pmol/L) 19.32 (20.15) 18.49 (21.32) 18.82 (20.15) 0.089
Hemoglobin (g/L) 95.45 ± 18.65 95.07 ± 18.75 95.49 ± 18.09 0.776
Platelet count (×109/L) 163.00 (75.57) 168.00 (74) 147.00 (73.75) 0.634
WBC count (×109/L) 5.32 (1.83) 5.225 (1.93) 5.24 (2.24) 0.991
IL-6 (pg/mL) 6.06 (6.59) 5.93 (5.54) 5.28 (5.51) <0.001
SF (μg/L) 195.00 (321.63) 51.24 (60.52.) 306.45 (329.69) <0.001
Transferrin (g/L) 1.86 (0.58) 2.14 (0.52) 1.78 (0.44) <0.001
Serum iron (μmol/L) 10.8 (6.32) 8.56 (4.92) 12.67 (5.62) <0.001
TSAT (%) 27.12 (16.48) 18.2 (9.36) 33.56 (15.47) <0.001
hsCRP (mg/L) 1.87 (4.89) 1.63 (3.71) 1.84 (3.68) 0.613
eGFR (mL/min) 4.23 (3.52) 3.68 (3.12) 3.78 (4.05) 0.315
nPCR 0.90 (0.25) 0.91 (0.28) 0.90 (0.27) 0.491
Weekly KT/V 2.04 (0.72) 2.04 (0.60) 2.02 (0.74) 0.365
D/P4h 0.67 ± 0.12 0.67 ± 0.12 0.68 ± 0.12 0.142
ESAs administration (%) 745 (66.0%) 63.8% 68.2% 0.257
Oral iron (%) 881 (78.1%) 76.2% 77.2% 0.918
Roxadustat (%) 176 (15.6%) 16.7% 15.9% 0.923

Note: BSA, body surface area; DM, diabetes mellitus; PTH, parathyroid hormone; WBC, white blood cell; eGFR, estimated glomerular filtration rate; IL-6, interleukin 6; SF, serum ferritin; nPCR, standardized protein nitrogen decomposition rate.

3.2 Iron metabolism and ID

The average SF was 276.8 ± 277.9 μg/L, with a median of 193.58 μg/L (interquartile spacing 319.68 μg/L), as shown in Figure 1. 32.8% (n = 370), 32.6% (n = 368), and 5.9% (n = 67) patients had SF < 100 μg/L, 100–300 μg/L, and ≥ 800 μg/L, respectively. The SF target rate was 50.2% (n = 566). The mean TSAT was (29.8 ± 12.7)%, with a median of 26.96% (interquartile spacing 16.12%) (Figure 2). The TSAT attainment rate was 69.3% (n = 782). TSAT < 20% in 23.8% (n = 268). 40.3% (n = 455) met the criteria of both serum SF and TSAT. 41.2% (n = 465) were diagnosed with relative ID, 15.7% (n = 177) had AID, and 8.1% (92 cases) had FID. Of patients with AID, 83.1% (n = 147) had taken oral iron. Among t881 patients treated with oral iron, 16.2% (n = 143) still had AID, and 39.6% (n = 349) had relative ID. Among 176 patients treated with Roxadustat, 48.9% (n = 86) had relative ID. Among them, 80.1% (n = 69) had SF < 100 μg/L.

Figure 1 SF (μg/L) distribution in initial PD patients. 32.8% (370) patients had SF < 100 μg/L, 32.6% (368) patients had SF in 100–300 μg/L, and 5.9% (67) patients had SF ≥ 800 μg/L.
Figure 1

SF (μg/L) distribution in initial PD patients. 32.8% (370) patients had SF < 100 μg/L, 32.6% (368) patients had SF in 100–300 μg/L, and 5.9% (67) patients had SF ≥ 800 μg/L.

Figure 2 Ferritin saturation (%) distribution in initial PD patients. The TSAT achievement rate was 69.3% (782 cases), TSAT < 20% was in 23.8% (268 cases), and TSAT ≥ 50% was in 6.9% (137 cases).
Figure 2

Ferritin saturation (%) distribution in initial PD patients. The TSAT achievement rate was 69.3% (782 cases), TSAT < 20% was in 23.8% (268 cases), and TSAT ≥ 50% was in 6.9% (137 cases).

3.3 Correlation analysis of iron metabolism index

Correlation analysis showed that SF was correlated with male (r = 0.208, P < 0.001) and was positively correlated with BSA, pre-albumin, and serum creatinine. Serum albumin, hemoglobin, total cholesterol, platelet count, hs-CRP, total KT/V, use of EPO, and Roxadustat were negatively correlated with SF. TSAT was associated with age, sex, diabetes mellitus, total cholesterol, platelet count, and IL-6 (Table 2).

Table 2

Correlation analysis of SF and ferritin saturation

SF Ferritin saturation
r P r P
Gender 0.206 0.000 0.094 0.004
Age −0.021 0.573 −0.133 0.001
BSA 0.1161 0.000 0.034 0.389
DM 0.014 0.612 −0.075 0.021
Albumin −0.082 0.039 −0.014 0.721
Prealbumin 0.089 0.013 0.076 0.058
Urea 0.002 0.968 −0.026 0.521
Creatinine 0.123 0.002 0.069 0.082
Triglyceride 0.057 0.143 −0.012 0.768
Cholesterol −0.086 0.024 −0.107 0.007
Calcium −0.071 0.073 0.001 0.982
Phosphorus −0.006 0.835 −0.04 0.32
PTH 0.032 0.544 0.004 0.925
Hemoglobin −0.083 0.035 0.061 0.126
Platelet count −0.173 0.000 −0.219 0.000
WBC count 0.013 0.761 −0.074 0.062
IL-6 0.056 0.168 −0.162 0.000
hs-CRP 0.161 0.000 −0.069 0.097
eGFR −0.027 0.48 0.013 0.739
nPCR −0.0622 0.128 0.025 0.533
Total KT/V −0.115 0.003 −0.011 0.791
D/P4h 0.046 0.256 −0.004 0.911
ESAs −0.067 0.035 −0.058 0.148
Oral iron −0.056 0.147 0.012 0.768
Roxadustat −0.024 0.027 0.035 0.576

3.4 Analysis of influencing factors of SF

In the multivariate linear regression analysis, SF was taken as the dependent variable. Gender, serum albumin, pre-albumin, serum creatinine, total cholesterol, hemoglobin, platelet count, hs-CRP, BSA, total KT/V, ESAs, and Roxadustat input were taken as the independent variables. Multivariate linear regression analysis demonstrated that gender, serum albumin, pre-albumin, platelet count, and hs-CRP were independently associated with SF (Table 3).

Table 3

Multivariate analysis of SF in initial PD patients

B SE Beta t P 95% CI
Constant 525.735 185.497 2.834 0.005 161.379–890.09
Male 66.955 33.25 0.113 2.014 0.045 1.646–132.264
Cholesterol −1.295 11.404 −0.005 −0.114 0.910 −23.695 to 21.105
Platelet count −0.782 0.214 −0.16 −3.651 0.000 −1.203 to −0.361
Creatinine 0.072 0.053 0.068 1.361 0.174 −0.032 to 0.176
Albumin −11.898 2.819 −0.208 −4.221 0.000 −17.434 to −6.361
Hemoglobin −0.274 0.74 −0.018 −0.37 0.711 −1.728 to 1.18
Prealbumin 0.744 0.17 0.228 4.383 0.000 0.411 to 1.077
hs-CRP 4.673 1.021 0.199 4.578 0.000 2.668 to 6.677
KT/V 47.999 24.542 0.096 1.956 0.051 −0.208 to 96.205
ESAs −41.859 23.821 −0.071 −1.757 0.079 −88.648 to 4.931
BSA −69.508 89.305 −0.042 −0.778 0.437 −244.923 to 105.907
Roxadustat −34.767 9.098 0.016 −1.531 0.528 −76.765–

3.5 Analysis of factors affecting TSAT

In multivariate linear regression analysis, TSAT was utilized as the dependent variable and associated factors (age, gender, diabetes mellitus, total cholesterol, platelet count, and IL-6) showed that platelet count, diabetes mellitus, and IL-6 were the independent factors of TSAT (Table 4).

Table 4

Multivariate analysis of TSAT in initial PD patients

B SE Beta t P 95% CI
Constant 37.653 3.195 11.784 0 31.377–43.93
Male 2.153 1.129 0.083 1.907 0.057 −0.065 to 4.372
Diabetes −3.338 1.521 −0.099 −2.194 0.029 −6.326 to −0.35
CHOL −0.478 0.506 −0.041 −0.945 0.345 −1.472 to 0.516
Age −0.027 0.041 −0.031 −0.669 0.504 −0.108 to 0.053
Platelet count −0.028 0.009 −0.132 −3.099 0.002 −0.045 to −0.010
IL-6 −0.059 0.024 −0.104 −2.479 0.013 −0.105 to −0.012

4 Discussion

PD is one of the alternative therapies for patients with end-stage renal failure. Despite the widespread use of ESAs, the incidence of anemia in PD patients is still high. In recent years, Roxadustat is also extensively chosen. Roxadustat is a novel agent with a distinct mechanism of action compared to ESAs and a potentially different combination of effects on iron parameters [6,7,8]. In 2012, the investigation results of 9 large dialysis centers in China showed that the incidence of anemia in 613 PD patients was 53.5% [9]. ID is the most common cause of low ESA response [10]. Few investigations have been carried out regarding the iron metabolisms of PD patients in China. In the present study, the SF and TSAT attainment rates of initial PD patients were 50.2 and 69.3%, respectively. 40.3% of patients reached both SF and TSAT attainment rates. The mean SF values were decreased in patients with initial PD who received Roxadustat in this study, which is consistent with the results of previous studies [6,7,8]. Of the patients treated with Roxadustat who had relative ID, 80.1% had SF < 100 μg/L. Significantly greater reductions in SF occurred following Roxadustat use in patients with non-dialysis-dependent (NDD) CKD compared to placebo use and in two of three studies in patients with dialysis-dependent (DD) CKD relative to ESAs use [11,12]. In a pooled analysis of three studies in NDD CKD patients and three studies in DD CKD patients from the ALPINE program, in patients with NDD CKD, SF was initially decreased through week 8 following Roxadustat initiation and gradually increased, but it remained below the baseline level. In contrast, patients with DD CKD experienced an initial decrease in SF at week 8 and subsequent gradual decreases through week 52 that were similar to, though greater than, decreases seen with ESAs.

In addition, 78.1% of the patients received oral iron supplements. Intravenous iron infusions were rare and only applied in less than 1% of patients (only three cases of intravenous iron infusion were screened in this study). In contrast to PD, intravenous iron is more widely used in HD patients, with 41–82% of HD patients using intravenous iron [2]. The reasons for PD patients rarely requiring iron infusions include PD patients not needing to go to the hospital frequently, having no ready vascular channel, the need to be hospitalized for intravenous iron transfusion unlike oral iron, etc., which reduces the compliance of PD patients with intravenous iron supplementation and limits the application and utility of intravenous iron. ID was still common in patients with initial PD, with 41.2% having relative ID and 15.7% having AID. International guidelines recommend oral iron supplementation for PD patients, the same as for CKD patients without dialysis. However, in this study, 16.2% of patients with oral iron supplementation were found to be AID. FID refers to normal or increased storage of iron, but an ID in cells is associated with inflammation. In this study, only 8.1% of PD patients had FID, lower than those in patients with HD and CKD. Previous studies reported that the prevalence of FID (defined as TSAT < 20% and SF > 200 μg/L) was 23% in HD patients [13], which may be related to the slighter inflammatory state of PD than HD [14]. The prevalence of FID (defined as TSAT < 20% and SF 100–300 μg/L) was 12% at stages 2 and 3 of CKD [15]. These differences may be caused by the study population, FID definition and iron treatment strategies. In terms of SF distribution, SF < 100 μg/L, <300 μg/L, and ≥800 μg/L of PD patients in this study were 32.8, 65.4, and 5.9%, respectively, similar to Japan (44, 83, and 3%) but vary significantly from the United States [2]. In the United States, only 5% of PD patients had SF less than 100 μg/L, while 39% had SF > 800 μg/L [2]. The high SF levels observed in the United States are probably caused by different management strategies. Although the recommended timing or low target line of iron supplementation was almost the same worldwide, the recommended upper limit of iron supplementation was different when SF < 100 μg/L. In China, the recommended upper limit of SF is 500 μg/L, while in Japan, the upper limit is more strict to avoid reaching >300 μg/L. In the United Kingdom, >800 μg/L is avoided, and in the United States, there is no upper limit. The low SF in this study is consistent with China’s guidelines for renal anemia. TSAT < 20% was observed in 23.8% of patients in this study, similar to Australia/New Zealand, Canada, and the United Kingdom (24–27%), but higher than in the United States (13%) and Japan (11%) [2]. No consensus has been reached on the reasonable target range of SF and TSAT.

Correlation and multivariate regression analyses indicated that women were more likely to have low SF, which was consistent with reports of low iron reserves in women in the general population and may be related to menstruation and vaginal bleeding [16]. SF was negatively correlated with serum albumin, whereas positively correlated with pre-albumin level. The correlation between serum albumin and pre-albumin, both nutritional indexes, and SF was contradictory. Among nutritional biomarkers, serum albumin is by far the most widely studied serum protein in maintenance dialysis patients [17]. However, serum albumin and pre-albumin are also affected by inflammation. The utility of using low serum albumin and low pre-albumin as a rationale for diagnosing malnutrition has been questioned in recent years. Reduced albumin and pre-albumin levels should not be considered a sign of malnutrition in the presence of an acute response (e.g., elevated CRP) when they serve as negative markers of acute response. Albumin has a longer half-life of about 21 days, while pre-albumin has a shorter half-life of about 1.9 days, which is similar to C-reactive protein, which has a half-life of 46.4 h. The shorter half-life of pre-albumin is likely a better indicator of recent nutritional status and inflammatory properties, while serum albumin’s longer half-life may better reflect nutritional reserves. Therefore, we believe that nutrient reserves are negatively correlated with SF, which may be due to protein consumption during the synthesis of SF or hemoglobin. Alternatively, it could also be related to disease states. Inflammatory cytokines including IL-6 and hs-CRP were independently associated with TSAT and SF, respectively, which is consistent with previous findings in the literature [18]. Increased hepatic iron regulation during inflammation inhibits intestinal iron absorption and release from macrophages, reducing iron reserves and iron utilization [19]. Iron metabolism was negatively correlated with platelet count. Earlier literature also features similar reports. In anemia patients with chronic disease, lower serum iron levels are associated with higher platelet counts [20]. Animal studies have shown increased platelet reactivity in ID anemia [21]. Intravenous iron supplementation has also been shown to reduce platelet count in CKD. Animal studies have reported that iron can inhibit the maturation of megakaryocytes. When iron is deficient, inhibition is weakened, the differentiation of megakaryocytes is accelerated, and megakaryocytes have higher ploidy, which leads to increased platelet production [21]. ID can cause secondary thrombocytopenia and platelet activation and even lead to thrombosis in patients with chronic diseases [14,22]. Iron supplementation and anticoagulant therapy can prevent the occurrence or recurrence of thrombosis in patients with ID [22]. However, ferritin levels were not associated with platelet count in healthy individuals [23]. Whether thrombocytopenia can be a predictor of ID in PD patients needs further study.

5 Study limitations

Several limitations have to be acknowledged in this study. First, all subjects in this study are initial PD patients. Although oral iron is generally absorbed quickly, relevant iron indexes may not reach a stable level immediately. Second, this study is a single-center retrospective study, with multiple biases such as selectivity. Third, differences in dietary habits may also lead to differences in iron intake. Hence, the results only reflect the PD population in the western region of China.

6 Conclusion

Taken together, the prevalence of ID remains high in patients with initial PD. Oral iron supplementation alone may not treat ID in some patients with initial PD. Roxadustat use is correlated with a greater reduction in SF levels compared with ESAs and an increase in serum iron levels compared to a decrease with ESAs. A decline in TSAT in patients treated with Roxadustat is relatively small. These changes can reflect the increases in both serum iron and total iron-binding capacity. Iron metabolism is affected by gender and inflammation levels, and it is independently associated with platelet count. Increased platelet count may be a predictor of ID. SF levels should be fully assessed before using Roxadustat, and iron reserves should be appropriately increased. In our future research, we plan to design a prospective randomized controlled multi-center study and stratify patient age, aiming to further validate the conclusion that thrombocytopenia can be a predictor of ID in PD patients.

Abbreviations

CAPD

continuous ambulatory peritoneal dialysis

ESRD

end-stage renal disease

ID

iron deficiency

AID

absolute iron deficiency

FID

functional iron deficiency

HD

hemodialysis

PD

peritoneal dialysis

ESAs

erythropoiesis-stimulating agents

HIF-PHI

hypoxic inducible factor prolyl hydroxylase inhibitor

SF

serum ferritin

TSAT

transferrin saturation

hs-CRP

high-sensitivity c-reactive protein

IL-6

interleukin 6

PTH

parathyroid hormone

BSA

body surface area

eGFR

estimate of glomerular filtration rate

NDD

non-dialysis dependent

CKD

chronic kidney disease

DD

dialysis dependent

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Acknowledgements

Not applicable.

  1. Funding information: This study was funded by the Science and Technology Department of Sichuan Province of China (Grants 2022YFS0330).

  2. Author contributions: QHY is responsible for the study concepts and design, the definition of intellectual content, clinical studies, experimental studies, data acquisition and analysis, statistical analysis, and manuscript preparation; NG is responsible for the clinical studies and data acquisition; PF is responsible for the literature research; HZ is responsible for the guarantor of integrity of the entire study, clinical studies, data acquisition, data analysis, statistical analysis, manuscript editing, and review. All authors read and approved the final article.

  3. Conflict of interest: There are no potential conflicts of interest to disclose.

  4. Data availability statement: All data generated or analyzed during this study are included in this. Further enquiries can be directed to the corresponding author.

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Received: 2024-03-14
Revised: 2024-07-12
Accepted: 2024-08-16
Published Online: 2024-09-17

© 2024 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  3. STK11 (LKB1) mutation suppresses ferroptosis in lung adenocarcinoma by facilitating monounsaturated fatty acid synthesis
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https://doi.org/10.1515/med-2024-1035
Keywords for this article
peritoneal dialysis; serum ferritin; ferritin saturation; iron deficiency; inflammation
Creative Commons
BY 4.0

Articles in the same Issue

  1. Research Articles
  2. EDNRB inhibits the growth and migration of prostate cancer cells by activating the cGMP-PKG pathway
  3. STK11 (LKB1) mutation suppresses ferroptosis in lung adenocarcinoma by facilitating monounsaturated fatty acid synthesis
  4. Association of SOX6 gene polymorphisms with Kashin-Beck disease risk in the Chinese Han population
  5. The pyroptosis-related signature predicts prognosis and influences the tumor immune microenvironment in dedifferentiated liposarcoma
  6. METTL3 attenuates ferroptosis sensitivity in lung cancer via modulating TFRC
  7. Identification and validation of molecular subtypes and prognostic signature for stage I and stage II gastric cancer based on neutrophil extracellular traps
  8. Novel lumbar plexus block versus femoral nerve block for analgesia and motor recovery after total knee arthroplasty
  9. Correlation between ABCB1 and OLIG2 polymorphisms and the severity and prognosis of patients with cerebral infarction
  10. Study on the radiotherapy effect and serum neutral granulocyte lymphocyte ratio and inflammatory factor expression of nasopharyngeal carcinoma
  11. Transcriptome analysis of effects of Tecrl deficiency on cardiometabolic and calcium regulation in cardiac tissue
  12. Aflatoxin B1 induces infertility, fetal deformities, and potential therapies
  13. Serum levels of HMW adiponectin and its receptors are associated with cytokine levels and clinical characteristics in chronic obstructive pulmonary disease
  14. METTL3-mediated methylation of CYP2C19 mRNA may aggravate clopidogrel resistance in ischemic stroke patients
  15. Understand how machine learning impact lung cancer research from 2010 to 2021: A bibliometric analysis
  16. Pressure ulcers in German hospitals: Analysis of reimbursement and length of stay
  17. Metformin plus L-carnitine enhances brown/beige adipose tissue activity via Nrf2/HO-1 signaling to reduce lipid accumulation and inflammation in murine obesity
  18. Downregulation of carbonic anhydrase IX expression in mouse xenograft nasopharyngeal carcinoma model via doxorubicin nanobubble combined with ultrasound
  19. Feasibility of 3-dimensional printed models in simulated training and teaching of transcatheter aortic valve replacement
  20. miR-335-3p improves type II diabetes mellitus by IGF-1 regulating macrophage polarization
  21. The analyses of human MCPH1 DNA repair machinery and genetic variations
  22. Activation of Piezo1 increases the sensitivity of breast cancer to hyperthermia therapy
  23. Comprehensive analysis based on the disulfidptosis-related genes identifies hub genes and immune infiltration for pancreatic adenocarcinoma
  24. Changes of serum CA125 and PGE2 before and after high-intensity focused ultrasound combined with GnRH-a in treatment of patients with adenomyosis
  25. The clinical value of the hepatic venous pressure gradient in patients undergoing hepatic resection for hepatocellular carcinoma with or without liver cirrhosis
  26. Development and validation of a novel model to predict pulmonary embolism in cardiology suspected patients: A 10-year retrospective analysis
  27. Downregulation of lncRNA XLOC_032768 in diabetic patients predicts the occurrence of diabetic nephropathy
  28. Circ_0051428 targeting miR-885-3p/MMP2 axis enhances the malignancy of cervical cancer
  29. Effectiveness of ginkgo diterpene lactone meglumine on cognitive function in patients with acute ischemic stroke
  30. The construction of a novel prognostic prediction model for glioma based on GWAS-identified prognostic-related risk loci
  31. Evaluating the impact of childhood BMI on the risk of coronavirus disease 2019: A Mendelian randomization study
  32. Lactate dehydrogenase to albumin ratio is associated with in-hospital mortality in patients with acute heart failure: Data from the MIMIC-III database
  33. CD36-mediated podocyte lipotoxicity promotes foot process effacement
  34. Efficacy of etonogestrel subcutaneous implants versus the levonorgestrel-releasing intrauterine system in the conservative treatment of adenomyosis
  35. FLRT2 mediates chondrogenesis of nasal septal cartilage and mandibular condyle cartilage
  36. Challenges in treating primary immune thrombocytopenia patients undergoing COVID-19 vaccination: A retrospective study
  37. Let-7 family regulates HaCaT cell proliferation and apoptosis via the ΔNp63/PI3K/AKT pathway
  38. Phospholipid transfer protein ameliorates sepsis-induced cardiac dysfunction through NLRP3 inflammasome inhibition
  39. Postoperative cognitive dysfunction in elderly patients with colorectal cancer: A randomized controlled study comparing goal-directed and conventional fluid therapy
  40. Long-pulsed ultrasound-mediated microbubble thrombolysis in a rat model of microvascular obstruction
  41. High SEC61A1 expression predicts poor outcome of acute myeloid leukemia
  42. Comparison of polymerase chain reaction and next-generation sequencing with conventional urine culture for the diagnosis of urinary tract infections: A meta-analysis
  43. Secreted frizzled-related protein 5 protects against renal fibrosis by inhibiting Wnt/β-catenin pathway
  44. Pan-cancer and single-cell analysis of actin cytoskeleton genes related to disulfidptosis
  45. Overexpression of miR-532-5p restrains oxidative stress response of chondrocytes in nontraumatic osteonecrosis of the femoral head by inhibiting ABL1
  46. Autologous liver transplantation for unresectable hepatobiliary malignancies in enhanced recovery after surgery model
  47. Clinical analysis of incomplete rupture of the uterus secondary to previous cesarean section
  48. Abnormal sleep duration is associated with sarcopenia in older Chinese people: A large retrospective cross-sectional study
  49. No genetic causality between obesity and benign paroxysmal vertigo: A two-sample Mendelian randomization study
  50. Identification and validation of autophagy-related genes in SSc
  51. Long non-coding RNA SRA1 suppresses radiotherapy resistance in esophageal squamous cell carcinoma by modulating glycolytic reprogramming
  52. Evaluation of quality of life in patients with schizophrenia: An inpatient social welfare institution-based cross-sectional study
  53. The possible role of oxidative stress marker glutathione in the assessment of cognitive impairment in multiple sclerosis
  54. Compilation of a self-management assessment scale for postoperative patients with aortic dissection
  55. Left atrial appendage closure in conjunction with radiofrequency ablation: Effects on left atrial functioning in patients with paroxysmal atrial fibrillation
  56. Effect of anterior femoral cortical notch grade on postoperative function and complications during TKA surgery: A multicenter, retrospective study
  57. Clinical characteristics and assessment of risk factors in patients with influenza A-induced severe pneumonia after the prevalence of SARS-CoV-2
  58. Analgesia nociception index is an indicator of laparoscopic trocar insertion-induced transient nociceptive stimuli
  59. High STAT4 expression correlates with poor prognosis in acute myeloid leukemia and facilitates disease progression by upregulating VEGFA expression
  60. Factors influencing cardiovascular system-related post-COVID-19 sequelae: A single-center cohort study
  61. HOXD10 regulates intestinal permeability and inhibits inflammation of dextran sulfate sodium-induced ulcerative colitis through the inactivation of the Rho/ROCK/MMPs axis
  62. Mesenchymal stem cell-derived exosomal miR-26a induces ferroptosis, suppresses hepatic stellate cell activation, and ameliorates liver fibrosis by modulating SLC7A11
  63. Endovascular thrombectomy versus intravenous thrombolysis for primary distal, medium vessel occlusion in acute ischemic stroke
  64. ANO6 (TMEM16F) inhibits gastrointestinal stromal tumor growth and induces ferroptosis
  65. Prognostic value of EIF5A2 in solid tumors: A meta-analysis and bioinformatics analysis
  66. The role of enhanced expression of Cx43 in patients with ulcerative colitis
  67. Choosing a COVID-19 vaccination site might be driven by anxiety and body vigilance
  68. Role of ICAM-1 in triple-negative breast cancer
  69. Cost-effectiveness of ambroxol in the treatment of Gaucher disease type 2
  70. HLA-DRB5 promotes immune thrombocytopenia via activating CD8+ T cells
  71. Efficacy and factors of myofascial release therapy combined with electrical and magnetic stimulation in the treatment of chronic pelvic pain syndrome
  72. Efficacy of tacrolimus monotherapy in primary membranous nephropathy
  73. Mechanisms of Tripterygium wilfordii Hook F on treating rheumatoid arthritis explored by network pharmacology analysis and molecular docking
  74. FBXO45 levels regulated ferroptosis renal tubular epithelial cells in a model of diabetic nephropathy by PLK1
  75. Optimizing anesthesia strategies to NSCLC patients in VATS procedures: Insights from drug requirements and patient recovery patterns
  76. Alpha-lipoic acid upregulates the PPARγ/NRF2/GPX4 signal pathway to inhibit ferroptosis in the pathogenesis of unexplained recurrent pregnancy loss
  77. Correlation between fat-soluble vitamin levels and inflammatory factors in paediatric community-acquired pneumonia: A prospective study
  78. CD1d affects the proliferation, migration, and apoptosis of human papillary thyroid carcinoma TPC-1 cells via regulating MAPK/NF-κB signaling pathway
  79. miR-let-7a inhibits sympathetic nerve remodeling after myocardial infarction by downregulating the expression of nerve growth factor
  80. Immune response analysis of solid organ transplantation recipients inoculated with inactivated COVID-19 vaccine: A retrospective analysis
  81. The H2Valdien derivatives regulate the epithelial–mesenchymal transition of hepatoma carcinoma cells through the Hedgehog signaling pathway
  82. Clinical efficacy of dexamethasone combined with isoniazid in the treatment of tuberculous meningitis and its effect on peripheral blood T cell subsets
  83. Comparison of short-segment and long-segment fixation in treatment of degenerative scoliosis and analysis of factors associated with adjacent spondylolisthesis
  84. Lycopene inhibits pyroptosis of endothelial progenitor cells induced by ox-LDL through the AMPK/mTOR/NLRP3 pathway
  85. Methylation regulation for FUNDC1 stability in childhood leukemia was up-regulated and facilitates metastasis and reduces ferroptosis of leukemia through mitochondrial damage by FBXL2
  86. Correlation of single-fiber electromyography studies and functional status in patients with amyotrophic lateral sclerosis
  87. Risk factors of postoperative airway obstruction complications in children with oral floor mass
  88. Expression levels and clinical significance of serum miR-19a/CCL20 in patients with acute cerebral infarction
  89. Physical activity and mental health trends in Korean adolescents: Analyzing the impact of the COVID-19 pandemic from 2018 to 2022
  90. Evaluating anemia in HIV-infected patients using chest CT
  91. Ponticulus posticus and skeletal malocclusion: A pilot study in a Southern Italian pre-orthodontic court
  92. Causal association of circulating immune cells and lymphoma: A Mendelian randomization study
  93. Assessment of the renal function and fibrosis indexes of conventional western medicine with Chinese medicine for dredging collaterals on treating renal fibrosis: A systematic review and meta-analysis
  94. Comprehensive landscape of integrator complex subunits and their association with prognosis and tumor microenvironment in gastric cancer
  95. New target-HMGCR inhibitors for the treatment of primary sclerosing cholangitis: A drug Mendelian randomization study
  96. Population pharmacokinetics of meropenem in critically ill patients
  97. Comparison of the ability of newly inflammatory markers to predict complicated appendicitis
  98. Comparative morphology of the cruciate ligaments: A radiological study
  99. Immune landscape of hepatocellular carcinoma: The central role of TP53-inducible glycolysis and apoptosis regulator
  100. Serum SIRT3 levels in epilepsy patients and its association with clinical outcomes and severity: A prospective observational study
  101. SHP-1 mediates cigarette smoke extract-induced epithelial–mesenchymal transformation and inflammation in 16HBE cells
  102. Acute hyper-hypoxia accelerates the development of depression in mice via the IL-6/PGC1α/MFN2 signaling pathway
  103. The GJB3 correlates with the prognosis, immune cell infiltration, and therapeutic responses in lung adenocarcinoma
  104. Physical fitness and blood parameters outcomes of breast cancer survivor in a low-intensity circuit resistance exercise program
  105. Exploring anesthetic-induced gene expression changes and immune cell dynamics in atrial tissue post-coronary artery bypass graft surgery
  106. Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism
  107. Analysis of the risk factors of the radiation-induced encephalopathy in nasopharyngeal carcinoma: A retrospective cohort study
  108. Reproductive outcomes in women with BRCA 1/2 germline mutations: A retrospective observational study and literature review
  109. Evaluation of upper airway ultrasonographic measurements in predicting difficult intubation: A cross-section of the Turkish population
  110. Prognostic and diagnostic value of circulating IGFBP2 in pancreatic cancer
  111. Postural stability after operative reconstruction of the AFTL in chronic ankle instability comparing three different surgical techniques
  112. Research trends related to emergence agitation in the post-anaesthesia care unit from 2001 to 2023: A bibliometric analysis
  113. Frequency and clinicopathological correlation of gastrointestinal polyps: A six-year single center experience
  114. ACSL4 mediates inflammatory bowel disease and contributes to LPS-induced intestinal epithelial cell dysfunction by activating ferroptosis and inflammation
  115. Affibody-based molecular probe 99mTc-(HE)3ZHER2:V2 for non-invasive HER2 detection in ovarian and breast cancer xenografts
  116. Effectiveness of nutritional support for clinical outcomes in gastric cancer patients: A meta-analysis of randomized controlled trials
  117. The relationship between IFN-γ, IL-10, IL-6 cytokines, and severity of the condition with serum zinc and Fe in children infected with Mycoplasma pneumoniae
  118. Paraquat disrupts the blood–brain barrier by increasing IL-6 expression and oxidative stress through the activation of PI3K/AKT signaling pathway
  119. Sleep quality associate with the increased prevalence of cognitive impairment in coronary artery disease patients: A retrospective case–control study
  120. Dioscin protects against chronic prostatitis through the TLR4/NF-κB pathway
  121. Association of polymorphisms in FBN1, MYH11, and TGF-β signaling-related genes with susceptibility of sporadic thoracic aortic aneurysm and dissection in the Zhejiang Han population
  122. Application value of multi-parameter magnetic resonance image-transrectal ultrasound cognitive fusion in prostate biopsy
  123. Laboratory variables‐based artificial neural network models for predicting fatty liver disease: A retrospective study
  124. Decreased BIRC5-206 promotes epithelial–mesenchymal transition in nasopharyngeal carcinoma through sponging miR-145-5p
  125. Sepsis induces the cardiomyocyte apoptosis and cardiac dysfunction through activation of YAP1/Serpine1/caspase-3 pathway
  126. Assessment of iron metabolism and iron deficiency in incident patients on incident continuous ambulatory peritoneal dialysis
  127. Tibial periosteum flap combined with autologous bone grafting in the treatment of Gustilo-IIIB/IIIC open tibial fractures
  128. The application of intravenous general anesthesia under nasopharyngeal airway assisted ventilation undergoing ureteroscopic holmium laser lithotripsy: A prospective, single-center, controlled trial
  129. Long intergenic noncoding RNA for IGF2BP2 stability suppresses gastric cancer cell apoptosis by inhibiting the maturation of microRNA-34a
  130. Role of FOXM1 and AURKB in regulating keratinocyte function in psoriasis
  131. Parental control attitudes over their pre-school children’s diet
  132. The role of auto-HSCT in extranodal natural killer/T cell lymphoma
  133. Significance of negative cervical cytology and positive HPV in the diagnosis of cervical lesions by colposcopy
  134. Echinacoside inhibits PASMCs calcium overload to prevent hypoxic pulmonary artery remodeling by regulating TRPC1/4/6 and calmodulin
  135. ADAR1 plays a protective role in proximal tubular cells under high glucose conditions by attenuating the PI3K/AKT/mTOR signaling pathway
  136. The risk of cancer among insulin glargine users in Lithuania: A retrospective population-based study
  137. The unusual location of primary hydatid cyst: A case series study
  138. Intraoperative changes in electrophysiological monitoring can be used to predict clinical outcomes in patients with spinal cavernous malformation
  139. Obesity and risk of placenta accreta spectrum: A meta-analysis
  140. Shikonin alleviates asthma phenotypes in mice via an airway epithelial STAT3-dependent mechanism
  141. NSUN6 and HTR7 disturbed the stability of carotid atherosclerotic plaques by regulating the immune responses of macrophages
  142. The effect of COVID-19 lockdown on admission rates in Maternity Hospital
  143. Temporal muscle thickness is not a prognostic predictor in patients with high-grade glioma, an experience at two centers in China
  144. Luteolin alleviates cerebral ischemia/reperfusion injury by regulating cell pyroptosis
  145. Therapeutic role of respiratory exercise in patients with tuberculous pleurisy
  146. Effects of CFTR-ENaC on spinal cord edema after spinal cord injury
  147. Irisin-regulated lncRNAs and their potential regulatory functions in chondrogenic differentiation of human mesenchymal stem cells
  148. DMD mutations in pediatric patients with phenotypes of Duchenne/Becker muscular dystrophy
  149. Combination of C-reactive protein and fibrinogen-to-albumin ratio as a novel predictor of all-cause mortality in heart failure patients
  150. Significant role and the underly mechanism of cullin-1 in chronic obstructive pulmonary disease
  151. Ferroptosis-related prognostic model of mantle cell lymphoma
  152. Observation of choking reaction and other related indexes in elderly painless fiberoptic bronchoscopy with transnasal high-flow humidification oxygen therapy
  153. A bibliometric analysis of Prader-Willi syndrome from 2002 to 2022
  154. The causal effects of childhood sunburn occasions on melanoma: A univariable and multivariable Mendelian randomization study
  155. Oxidative stress regulates glycogen synthase kinase-3 in lymphocytes of diabetes mellitus patients complicated with cerebral infarction
  156. Role of COX6C and NDUFB3 in septic shock and stroke
  157. Trends in disease burden of type 2 diabetes, stroke, and hypertensive heart disease attributable to high BMI in China: 1990–2019
  158. Purinergic P2X7 receptor mediates hyperoxia-induced injury in pulmonary microvascular endothelial cells via NLRP3-mediated pyroptotic pathway
  159. Investigating the role of oviductal mucosa–endometrial co-culture in modulating factors relevant to embryo implantation
  160. Analgesic effect of external oblique intercostal block in laparoscopic cholecystectomy: A retrospective study
  161. Elevated serum miR-142-5p correlates with ischemic lesions and both NSE and S100β in ischemic stroke patients
  162. Correlation between the mechanism of arteriopathy in IgA nephropathy and blood stasis syndrome: A cohort study
  163. Risk factors for progressive kyphosis after percutaneous kyphoplasty in osteoporotic vertebral compression fracture
  164. Predictive role of neuron-specific enolase and S100-β in early neurological deterioration and unfavorable prognosis in patients with ischemic stroke
  165. The potential risk factors of postoperative cognitive dysfunction for endovascular therapy in acute ischemic stroke with general anesthesia
  166. Fluoxetine inhibited RANKL-induced osteoclastic differentiation in vitro
  167. Detection of serum FOXM1 and IGF2 in patients with ARDS and their correlation with disease and prognosis
  168. Rhein promotes skin wound healing by activating the PI3K/AKT signaling pathway
  169. Differences in mortality risk by levels of physical activity among persons with disabilities in South Korea
  170. Review Articles
  171. Cutaneous signs of selected cardiovascular disorders: A narrative review
  172. XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis
  173. A narrative review on adverse drug reactions of COVID-19 treatments on the kidney
  174. Emerging role and function of SPDL1 in human health and diseases
  175. Adverse reactions of piperacillin: A literature review of case reports
  176. Molecular mechanism and intervention measures of microvascular complications in diabetes
  177. Regulation of mesenchymal stem cell differentiation by autophagy
  178. Molecular landscape of borderline ovarian tumours: A systematic review
  179. Advances in synthetic lethality modalities for glioblastoma multiforme
  180. Investigating hormesis, aging, and neurodegeneration: From bench to clinics
  181. Frankincense: A neuronutrient to approach Parkinson’s disease treatment
  182. Sox9: A potential regulator of cancer stem cells in osteosarcoma
  183. Early detection of cardiovascular risk markers through non-invasive ultrasound methodologies in periodontitis patients
  184. Advanced neuroimaging and criminal interrogation in lie detection
  185. Maternal factors for neural tube defects in offspring: An umbrella review
  186. The chemoprotective hormetic effects of rosmarinic acid
  187. CBD’s potential impact on Parkinson’s disease: An updated overview
  188. Progress in cytokine research for ARDS: A comprehensive review
  189. Utilizing reactive oxygen species-scavenging nanoparticles for targeting oxidative stress in the treatment of ischemic stroke: A review
  190. NRXN1-related disorders, attempt to better define clinical assessment
  191. Lidocaine infusion for the treatment of complex regional pain syndrome: Case series and literature review
  192. Trends and future directions of autophagy in osteosarcoma: A bibliometric analysis
  193. Iron in ventricular remodeling and aneurysms post-myocardial infarction
  194. Case Reports
  195. Sirolimus potentiated angioedema: A case report and review of the literature
  196. Identification of mixed anaerobic infections after inguinal hernia repair based on metagenomic next-generation sequencing: A case report
  197. Successful treatment with bortezomib in combination with dexamethasone in a middle-aged male with idiopathic multicentric Castleman’s disease: A case report
  198. Complete heart block associated with hepatitis A infection in a female child with fatal outcome
  199. Elevation of D-dimer in eosinophilic gastrointestinal diseases in the absence of venous thrombosis: A case series and literature review
  200. Four years of natural progressive course: A rare case report of juvenile Xp11.2 translocations renal cell carcinoma with TFE3 gene fusion
  201. Advancing prenatal diagnosis: Echocardiographic detection of Scimitar syndrome in China – A case series
  202. Outcomes and complications of hemodialysis in patients with renal cancer following bilateral nephrectomy
  203. Anti-HMGCR myopathy mimicking facioscapulohumeral muscular dystrophy
  204. Recurrent opportunistic infections in a HIV-negative patient with combined C6 and NFKB1 mutations: A case report, pedigree analysis, and literature review
  205. Letter to the Editor
  206. Letter to the Editor: Total parenteral nutrition-induced Wernicke’s encephalopathy after oncologic gastrointestinal surgery
  207. Erratum
  208. Erratum to “Bladder-embedded ectopic intrauterine device with calculus”
  209. Retraction
  210. Retraction of “XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis”
  211. Corrigendum
  212. Corrigendum to “Investigating hormesis, aging, and neurodegeneration: From bench to clinics”
  213. Corrigendum to “Frankincense: A neuronutrient to approach Parkinson’s disease treatment”
  214. Special Issue The evolving saga of RNAs from bench to bedside - Part II
  215. Machine-learning-based prediction of a diagnostic model using autophagy-related genes based on RNA sequencing for patients with papillary thyroid carcinoma
  216. Unlocking the future of hepatocellular carcinoma treatment: A comprehensive analysis of disulfidptosis-related lncRNAs for prognosis and drug screening
  217. Elevated mRNA level indicates FSIP1 promotes EMT and gastric cancer progression by regulating fibroblasts in tumor microenvironment
  218. Special Issue Advancements in oncology: bridging clinical and experimental research - Part I
  219. Ultrasound-guided transperineal vs transrectal prostate biopsy: A meta-analysis of diagnostic accuracy and complication rates
  220. Assessment of diagnostic value of unilateral systematic biopsy combined with targeted biopsy in detecting clinically significant prostate cancer
  221. SENP7 inhibits glioblastoma metastasis and invasion by dissociating SUMO2/3 binding to specific target proteins
  222. MARK1 suppress malignant progression of hepatocellular carcinoma and improves sorafenib resistance through negatively regulating POTEE
  223. Analysis of postoperative complications in bladder cancer patients
  224. Carboplatin combined with arsenic trioxide versus carboplatin combined with docetaxel treatment for LACC: A randomized, open-label, phase II clinical study
  225. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part I
  226. Comprehensive pan-cancer investigation of carnosine dipeptidase 1 and its prospective prognostic significance in hepatocellular carcinoma
  227. Identification of signatures associated with microsatellite instability and immune characteristics to predict the prognostic risk of colon cancer
  228. Single-cell analysis identified key macrophage subpopulations associated with atherosclerosis
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