421-P: Ferritin and COVID-19 Infection and Outcomes in American Indian and Alaska Native Dialysis Patients with Diabetes

American Indians/Alaska Natives (AIAN) bear the greatest burden of diabetes and are overrepresented in the dialysis population. They were also hardest hit by COVID-19, w/higher mortality rates than any U.S. racial/ethnic group. Early in the pandemic, hyperferritinemia was prognostic of poor COVID-19 outcomes, including death. We determined the association of ferritin w/ COVID-19 infection, hospitalization, and mortality in AIAN dialysis patients w/ diabetes. We followed 1,065 AIAN in-center hemodialysis patients w/ diabetes from January 2020 to March 2022. For incident COVID infection, baseline ferritin was defined as the average from one year prior to two weeks prior to RT-PCR confirmed COVID-infection (days-365,-14). Change in ferritin was defined as the difference between the baseline average and two week prior average (-14,0) to the PCR positive test date. For non-infected patients, a randomly selected date following the distribution of PCR positive dates of COVID patients was chosen as the test date. Logistic regression assessed the association of ferritin and its change w/ COVID-19 infection, hospitalization and mortality, adjusting for age, sex, race, vaccination status, vintage, and lab values. During follow-up, the cumulative incidence of infection was 35.7%; in the infected, 26.7% were hospitalized and 12.6% died. While baseline ferritin was not linked to infection risk (p=0.42), TSAT (p=0.02) and ferritin change (p=0.09) were marginally. In the infected, ferritin two weeks prior to RT-PCR confirmed diagnosis were linked to hospitalization (p=0.02), while ferritin change was not (p=0.59). Neither baseline nor ferritin change was linked w/ mortality; but lower baseline hgb (p=0.09), higher neutrophils (p=0.09) and neutrophil to lymphocyte ratio (p=0.06) showed weak relationships w/ mortality. Ferritin was associated w/ future risk of COVID-19 infection and hospitalization but not mortality in AIAN dialysis patients w/ diabetes.