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Iron overload as cardiovascular risk factor in children and adolescents with renal disease
Ma de la Cruz Ruiz-Jaramillo1, Juan Manuel Guízar-Mendoza, Norma Amador-Licona
1Universidad de Guanajuato, Hospital General Regional de León, Mexico.
Insights
Children with iron overload on renal replacement therapy exhibit more cardiovascular risk factors, particularly those on hemodialysis. Iron overload is linked to inflammation and hypertension in this vulnerable pediatric population.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Health in Chronic Kidney Disease
- Iron Metabolism and Toxicity
Background:
- Iron overload in children undergoing renal replacement therapy can negatively impact cardiac structure and function.
- This overload contributes to free radical production and direct iron deposition within the myocardium.
- Understanding associated cardiovascular risk factors is crucial for managing these patients.
Purpose of the Study:
- To compare traditional and non-traditional cardiovascular risk factors (CVRF) in pediatric patients with and without iron overload undergoing renal replacement therapy.
- To investigate the relationship between iron overload and left ventricular mass (LVM) in this population.
Main Methods:
- A cross-sectional study evaluated CVRF in 143 children and adolescents on peritoneal dialysis (PD), hemodialysis (HD), or post-renal transplantation, stratified by iron overload status.
- A case-control study subsequently measured LVM in a subgroup of 12 patients with iron overload and 12 matched controls.
Main Results:
- Iron overload was present in 10.5% of patients, predominantly those on HD.
- Patients with iron overload had lower BMI, total cholesterol, and hemoglobin, but higher IL-6 levels and hypertension rates.
- Ferritin correlated positively with C-reactive protein (CRP) and IL-6, with a borderline correlation to LVM.
Conclusions:
- Children and adolescents with iron overload, particularly those treated with HD, present with a higher burden of CVRFs.
- Ferritin levels are associated with inflammatory markers like CRP and IL-6 in this cohort.
- While LVM was not significantly different, the trend suggests a potential link requiring further investigation.
Background:
Iron overload can affect cardiac structure and function by the production of free radicals in addition to iron deposits in heart muscle. The purpose of this study was to compare traditional and non-traditional cardiovascular risk factors (CVRF) in children and adolescents on renal replacement with and without iron overload. Also, we evaluated the relationships between iron overload and left ventricular mass (LVM).
Methods:
First, in a cross-sectional study, we evaluated traditional and non-traditional CVRF in 143 children and adolescents, 48 on peritoneal dialysis (PD), 53 on hemodialysis (HD) and 42 after renal transplantation according to iron overload. In a second phase with a case-control study, we measured LVM in 12 case patients and 12 matched controls.
Results:
Iron overload was identified in 15 patients (10.5%), 11 in HD and 4 in PD (P = 0.002). The group with iron overload had lower body mass index (17 versus 19; P = 0.01), total cholesterol (132 versus 165 mg/dL; P = 0.03) and hemoglobin (8.5 versus 10.6 g/dL; P = 0.003) but higher interleukin (IL)-6 levels (4.8 versus 3.6 ng/L; P = 0.04) and hypertension diagnosis (79 versus 48%; P < 0.001) than those without iron overload. Ferritin showed a positive correlation with C-reactive protein (CRP) and IL-6 levels. In a subgroup of 24 patients (12 with and 12 without iron overload), LVM was not different. However, ferritin levels showed a borderline positive correlation (r = 0.44, P = 0.05) with LVM.
Conclusion:
Children and adolescents with iron overload show more CVRFs, especially if they received replacement therapy with HD. Ferritin is related to CRP and IL-6 levels.
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