Article
Open Access
Volume 6 · Issue 2 · 2026
pp. 69–76
Ischemia-Modified Albumin as a Predictor of Anemia in Hemodialysis Patients: An Exploratory Cross-Sectional Study
Hatice Asoglu1 
, Berfu Korucu3 , Hasan Yeter4 , Hacer Demirkose6 , Dilek Yapar7 , Omer Faruk Akcay2 , Musa Bali65
, Berfu Korucu3 , Hasan Yeter4 , Hacer Demirkose6 , Dilek Yapar7 , Omer Faruk Akcay2 , Musa Bali65
1
Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Türkiye; Department of Medical Oncology, Cukurova University Faculty of Medicine, Adana, Türkiye
2
Division of Nephrology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Türkiye
3
Division of Nephrology, Dokuz Eylul University, Izmir, Türkiye
4
Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
5
Ankara Bali Dialysis Center, Ankara, Türkiye
6
General Directorate of Public Health, Department of Communicable Diseases and Early Warning, Ministry of Health, Ankara, Türkiye
7
Department of Biostatistics and Medical Informatics, Faculty of Medicine, Akdeniz University, Antalya, Türkiye
Abstract
Objectives: Ischemia-modified albumin (IMA) is a biomarker of oxidative stress. Its relationship with anemia in hemodi-alysis (HD) patients remains unclear. This study aimed to evaluate the association between IMA and hemoglobin (Hb) in HD patients and to determine whether IMA can predict anemia.
Methods: This cross-sectional study enrolled 85 maintenance HD patients. IMA was measured using the albumin co-balt-binding assay. Anemia was defined as Hb<11 g/dL according to the KDIGO guidelines.
Results: IMA correlated inversely with Hb (r=−0.341; p=0.001). Multivariate linear regression identified Hb (β=−0.033; p=0.002) and ultrafiltration volume (β<0.001; p=0.001) as independent predictors of IMA (adjusted R²=0.43). ROC analy-sis yielded an optimal IMA cutoff of ≥0.635 absorbance units (ABSU) (AUC=0.700; 95% CI, 0.582–0.817; p=0.002; sensitiv-ity, 61.3%; specificity, 63.0%). In logistic regression, IMA≥0.635 ABSU (OR, 7.21; p=0.037) and EPO resistance (OR, 14.09; p=0.002) were independent predictors of anemia.
Conclusion: IMA levels were significantly elevated in anemic HD patients. An IMA cutoff of ≥0.635 ABSU showed moder-ate predictive capacity for anemia, suggesting its potential as a supplementary biomarker. Larger prospective studies are needed for validation.
Methods: This cross-sectional study enrolled 85 maintenance HD patients. IMA was measured using the albumin co-balt-binding assay. Anemia was defined as Hb<11 g/dL according to the KDIGO guidelines.
Results: IMA correlated inversely with Hb (r=−0.341; p=0.001). Multivariate linear regression identified Hb (β=−0.033; p=0.002) and ultrafiltration volume (β<0.001; p=0.001) as independent predictors of IMA (adjusted R²=0.43). ROC analy-sis yielded an optimal IMA cutoff of ≥0.635 absorbance units (ABSU) (AUC=0.700; 95% CI, 0.582–0.817; p=0.002; sensitiv-ity, 61.3%; specificity, 63.0%). In logistic regression, IMA≥0.635 ABSU (OR, 7.21; p=0.037) and EPO resistance (OR, 14.09; p=0.002) were independent predictors of anemia.
Conclusion: IMA levels were significantly elevated in anemic HD patients. An IMA cutoff of ≥0.635 ABSU showed moder-ate predictive capacity for anemia, suggesting its potential as a supplementary biomarker. Larger prospective studies are needed for validation.
Keywords: Anemia, chronic kidney disease, erythropoietin resistance, hemodialysis, ischemia-modified albumin, oxida-tive stress
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