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Iron, coronary artery calcification, and mortality in patients undergoing hemodialysis
Sonoo Mizuiri1, Yoshiko Nishizawa1, Toshiki Doi1,2
1Division of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan.
Insights
Iron deficiency, indicated by low transferrin saturation (TSAT) and serum iron, is linked to higher coronary artery calcification scores (CACS) and increased mortality risk in hemodialysis patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Hematology
Background:
- High coronary artery calcification score (CACS) is a significant predictor of mortality in patients undergoing hemodialysis (HD).
- Emerging research suggests a role for iron metabolism in vascular calcification processes.
Purpose of the Study:
- To investigate the association between iron status (serum iron, transferrin saturation [TSAT], ferritin) and CACS in HD patients.
- To determine the relationship between iron parameters, CACS, and 5-year all-cause mortality in this patient cohort.
Main Methods:
- A cohort of 173 maintenance HD patients was analyzed.
- Patients were categorized based on CACS (≥400 vs. <400).
- Logistic and Cox proportional hazard regression models were used to assess associations with CACS and mortality.
Main Results:
- Lower serum iron and TSAT levels were observed in patients with CACS ≥400.
- TSAT ≥21% was independently associated with a lower likelihood of CACS ≥400 (OR 0.46, p<0.05).
- Adequate TSAT (≥17%), serum iron (≥63 µg/dL), and ferritin (≥200 ng/mL) were associated with reduced 5-year all-cause mortality.
Conclusions:
- Low TSAT is an independent predictor of high CACS in HD patients.
- Iron deficiency, characterized by low TSAT, serum iron, or ferritin, significantly predicts increased 5-year all-cause mortality.
- These findings highlight the importance of monitoring iron status in HD patients to mitigate cardiovascular risk and mortality.
Objective:
A high coronary artery calcification score (CACS) may be associated with high mortality in patients undergoing hemodialysis (HD). Recently, effects of iron on vascular smooth muscle cell calcification have been described. We aimed to investigate the relationships between iron, CACS, and mortality in HD patients.
Methods:
We studied 173 consecutive patients who were undergoing maintenance HD. Laboratory data and Agatston's CACS were obtained at baseline for two groups of patients: those with CACS ≥400 (n = 109) and those with CACS <400 (n = 64). Logistic regression analyses for CACS ≥400 and Cox proportional hazard analyses for mortality were conducted.
Results:
The median (interquartile range) age and duration of dialysis of the participants were 67 (60-75) years and 73 (37-138) months, respectively. Serum iron (Fe) and transferrin saturation (TSAT) levels were significantly lower in participants with CACS ≥400 than in those with CACS <400, although the serum ferritin concentration did not differ between the groups. TSAT ≥21% was significantly associated with CACS ≥400 (odds ratio 0.46, p<0.05). TSAT ≥17%, Fe ≥63 µg/dL, and ferritin ≥200 ng/mL appear to protect against 5-year all-cause mortality in HD patients, independent of conventional risk factors of all-cause mortality (p < 0.05).
Conclusion:
We have identified associations between iron, CACS, and mortality in HD patients. Lower TSAT was found to be an independent predictor of CACS ≥400, and iron deficiency (low TSAT, iron, or ferritin) was a significant predictor of 5-year all-cause mortality in HD patients.
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