#6917 IMPACT OF FUNCTIONAL IRON DEFICIENCY IN NON-ANEMIC HEMODIALYSIS PATIENT ON NEUROCOGNITIVE AND QUALITY OF LIFE: A SINGLE CENTER CROSS-SECTION STUDY
Authors: Attiya Ahmed Mohamed Naguib , Abdulaziz Hoda , Elwasif Salwa , Gad Donia , Saad Walaa , Aziz Hager Abd el , Sally Samir , Sobh Mohamed 
Published: June 2023

Abstract

Background and Aims
The clinical paradox of high ferritin levels and low TSAT is a condition known as "functional iron deficiency." This occurs when the body has adequate iron stores, as indicated by high ferritin levels, but the iron is not available for use in the body, as indicated by low TSAT levels. This can be caused by inflammation, chronic disease, or other conditions that interfere with the body's ability to absorb and utilize iron. Hemodialysis patients may suffer from both absolute and functional iron deficiency. Most studies was directed to study effect of absolute iron deficiency even without anemia, and the important of supplementing with oral or intravenous iron ; however, impact of functional iron deficiency without anemia and subsequently decision of iron supplementation especially in presence of high ferritin is still undetermined.
Our aim is to assess the impact of functional iron deficiency without anemia in neurocognitive function and quality of life among hemodialysis patients in dialysis unit in urology and nephrology center Mansoura University.

Method
Patients on regular haemodialysis were screened using complete blood picture, transferrin saturation (TSAT) and serum ferritin to determine iron status. The Saint Louis University Mental Status assessed cognitive function. (SLUMS) Examination used for detecting mild cognitive impairment and dementia. Quality of life was assessed by 36-item short-form (SF-36). The SF-36 measures eight scales: physical functioning (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE), and mental health (MH).

Results
Among 70 patients maintained on regular hemodialysis, A 42 patients have normal hemoglobin level (above 12 mg/dl with high serum ferritin &gt;300 ng/mL). They classified into two group: A 26 patients with high ferritin, high TSAT &gt;20%, and normochromic red blood cells, A 16 patients with high ferritin level,low TSAT&lt;20% and hypochromic red blood cells. Among the 26 patients, 17 male and 9 female, and among the 16 patients, 11 male and 5 female. The 26 patients have mean age of (41 +/- 13) and the 16 patients have mean age of (39 +/- 10). No significant difference between the two groups regarding sex and age with p value (0.5 and 0.1 respectively). Assessment of cognitive function by SLUM score revealed regarding normal group (4 have normal score, 18 have mild impairment of cognitive function and 4 have dementia score) and the iron deficient group (4 have normal score, 9 have mild impairment of cognitive function and 3 have dementia score) with no statistically different between the two group (P = .6).requarding quality of life, no statistically difference was fond between the two group regarding : physical functioning (p= 0.18), role physical (P = .11), bodily pain (p = 0.33), general health (p= 0.5), vitality (P = .41), social functioning (P = .2), role emotional (P = .4), and mental health (P = .21 ).

Conclusion
Non-anemic hemodialysis Patients with Functional iron deficiency has no statistically difference regarding neurocognitive function and quality of life from normal iron non-anemic patients.