Background Chronic kidney disease (CKD) constitutes one of the most important global health challenges and iron deficiency (ID) anemia are both frequent complications, especially in patients on dialysis. Dialysis treatment is an important aspect of addressing these complications, yet the treatment adherence rate is low in CKD patients and the association between dialysis adherence and differences in iron profiles among CKD patients is unclear. Objectives This study aimed to assess differences in iron profile in dialysis-adherent and non-adherent chronic kidney disease subjects and analyze the profiles between both groups. Methods One hundred twenty patients undergoing hemodialysis were included in this cross-sectional study, divided into two groups based on two subcategories of dialysis adherence- adherent (n=60) and nonadherent (n=60). The parameters of iron profile-also defined as serum ferritin, transferrin saturation (TSAT), hemoglobin, and serum iron-were studied. Further, multivariate regression analysis was carried out, adjusting possible confounders such as age, sex, diabetes, and duration of dialysis. Results: Serum ferritin was significantly higher among patients in the adherent group when compared with those in the non-adherent group (235.6 120.2 ng/mL vs. 185.2 105.3 ng/mL; p=0.03), TSAT (33.4 9.3% vs. 28.8 10.2%; p=0.02), and hemoglobin level (11.5 1.8 g/dL vs. 10.2 2.1 g/dL; p=0.04). That is, non-adherence to the therapy was associated with a significantly higher number of patients having iron deficiency anemia (63% in non-adherent vs. 40% in adherent patients; p=0.01). Multivariate analysis confirmed that dialysis adherence was independently associated with better iron status (p<0.05 for all parameters). Conclusion In hemodialysis patients, adherence to dialysis presents as a strong predictor of better iron profile. More "iron parameters" were better and showed a decreased reliance on iron deficiency anemia for adherents. Such improvement, however, may significantly reduce anemia-associated complications through strategies that improve adherence to dialysis treatment by optimizing iron metabolism among chronic kidney disease patients.

The authors have declared no competing interest.

No funding was received for this study.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study was approved by the hospital Institutional Research Board. All study participants provided written informed consent before enrollment. Confidentiality regarding participants was maintained throughout the study. ref: ISERC/KTRH/012/24

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

The data of the findings of this study are all shared in this article.