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Cardiorenal syndrome in thalassemia patients
Sorasak Makmettakul1,2, Adisak Tantiworawit3, Arintaya Phrommintikul4
1Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intravaroros Road, A. Muang, Chiang Mai, 50200, Thailand.
Insights
Cardiorenal syndrome (CRS) affects over a quarter of thalassemia patients, often linked to extramedullary hematopoiesis and pulmonary hypertension. Early detection through accessible lab tests is key for managing this condition.
Area of Science:
- Cardiology
- Nephrology
- Hematology
Background:
- Cardiorenal syndrome (CRS) is a severe condition with high morbidity and mortality, characterized by concurrent cardiac and renal dysfunction.
- Limited data exists on CRS in patients with thalassemia, a genetic blood disorder.
- This study investigates the prevalence and associated risk factors of CRS in thalassemia patients.
Purpose of the Study:
- To determine the prevalence of cardiorenal syndrome (CRS) in thalassemia patients.
- To identify risk factors associated with the development of CRS in this population.
Main Methods:
- A cross-sectional study enrolled 90 thalassemia patients from a tertiary care hospital.
- Clinical and laboratory data were collected over two visits, three months apart.
- CRS diagnosis followed established criteria for cardiac abnormalities and chronic kidney disease (KDIGO 2012).
Main Results:
- Cardiorenal syndrome (CRS) was diagnosed in 27.8% (25/90) of thalassemia patients.
- Significant associations were found between CRS and extramedullary hematopoiesis, specific thalassemia types (β0/βE), pulmonary hypertension, elevated NT-proBNP, and increased urinary magnesium.
- No association was observed with transfusion frequency, iron levels, or iron chelation therapy.
Conclusions:
- Cardiorenal syndrome (CRS) is a common complication in thalassemia patients.
- The presence of CRS correlates with easily measurable clinical and laboratory parameters, facilitating clinical assessment.
Background:
Cardiorenal syndrome (CRS), a serious condition with high morbidity and mortality, is characterized by the coexistence of cardiac abnormality and renal dysfunction. There is limited information about CRS in association thalassemia. This study aimed to investigate the prevalence of CRS in thalassemia patients and also associated risk factors.
Methods:
Thalassemia patients who attended the out-patient clinic of a tertiary care university hospital from October 2016 to September 2017 were enrolled onto this cross-sectional study. Clinical and laboratory findings from 2 consecutive visits, 3 months apart, were assessed. The criteria for diagnosis of CRS was based on a system proposed by Ronco and McCullough. Cardiac abnormalities are assessed by clinical presentation, establishment of acute or chronic heart failure using definitions from 2016 ESC guidelines or from structural abnormalities shown in an echocardiogram. Renal dysfunction was defined as chronic kidney disease according to the 2012 KDIGO guidelines.
Results:
Out of 90 thalassemia patients, 25 (27.8%) had CRS. The multivariable analysis showed a significant association between CRS and extramedullary hematopoiesis (EMH) (odds ratio (OR) 20.55, p = 0.016); thalassemia type [β0/βE vs β0/β0 thalassemia (OR 0.005, p = 0.002)]; pulmonary hypertension (OR 178.1, p = 0.001); elevated serum NT-proBNP (OR 1.028, p = 0.022), and elevated 24-h urine magnesium (OR 1.913, p = 0.016). There was no association found between CRS and frequency of blood transfusion, serum ferritin, liver iron concentration, cardiac T2*, type of iron chelating agents, or urine neutrophil gelatinase-associated lipocalin level.
Conclusions:
CRS is relatively common in thalassemia patients. Its occurrence is associated with laboratory parameters which are easily measured in clinical practice.
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