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Iron deficiency and iron therapy in heart failure and chronic kidney disease
Carl P Walther1, Jefferson L Triozzi2, Anita Deswal3
1Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health.
Insights
Iron deficiency negatively impacts heart failure and chronic kidney disease (CKD). Intravenous iron therapy shows promise for improving symptoms and function in heart failure and may benefit CKD patients.
Area of Science:
- Cardiology
- Nephrology
- Nutritional Science
Background:
- Iron deficiency is prevalent in heart failure (HF) and chronic kidney disease (CKD), linked to adverse outcomes.
- HF and CKD often coexist, complicating patient management.
- Iron deficiency can be absolute or functional, with or without anemia, in both conditions.
Purpose of the Study:
- To review current evidence on iron deficiency and supplementation in HF.
- To integrate findings with recent data on intravenous iron therapy in CKD.
- To assess the effectiveness and safety of iron therapy in these comorbid conditions.
Main Methods:
- Literature review of available evidence.
- Survey of ongoing studies on iron deficiency and supplementation.
- Integration of recent findings on intravenous iron therapy in CKD.
Main Results:
- Intravenous iron improves HF symptoms and physical function in HF with reduced ejection fraction and iron deficiency, potentially reducing hospitalizations and mortality.
- Sustained IV iron in end-stage kidney disease patients on hemodialysis improves outcomes without apparent infectious complications.
- Iron therapy appears safe in the short term for both HF and CKD.
Conclusions:
- Iron therapy has significant effects in HF and CKD.
- Ongoing trials are crucial for further understanding risks and benefits.
- Short-term safety is established, but long-term data and specific patient selection require continued investigation.
Purpose Of Review:
Iron deficiency is common and associated with adverse outcomes in heart failure, regardless of anemia. Iron deficiency, absolute and functional, with and without anemia, is associated with adverse outcomes in chronic kidney disease (CKD). Heart failure and CKD frequently occur together. Intravenous iron therapy has been shown to reduce heart failure symptoms and improve physical function in heart failure with reduced ejection fraction with iron deficiency. In CKD, intravenous or oral iron therapy are often used for management of anemia, along with erythropoiesis stimulating agents, yet the risks and benefits of intravenous iron use is controversial. In this review, we survey available evidence and ongoing studies of iron deficiency and iron supplementation in heart failure, and integrate with recent evidence on effectiveness and safety of intravenous iron therapy in CKD.
Recent Findings:
Intravenous iron therapy improves heart failure symptoms and physical function in heart failure with reduced ejection fraction and iron deficiency, regardless of anemia, and may reduce heart failure hospitalizations and cardiovascular mortality. Sustained intravenous iron therapy regardless of hemoglobin level in selected patients with end-stage kidney disease receiving hemodialysis improves outcomes, and does not appear to cause infectious complications.
Summary:
Iron therapy has important effects in heart failure and CKD, and appears safe in the short term. Ongoing trials will provide additional important information.
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