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Updated: Jun 30, 2025
A Semi-Automated and Reproducible Biological-Based Method to Quantify Calcium Deposition In Vitro
Published on: June 2, 2022
Absolute iron deficiency, coronary artery calcification and cardiovascular mortality in maintenance haemodialysis
Sonoo Mizuiri1, Yoshiko Nishizawa1, Kazuomi Yamashita1
1Division of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan.
Insights
Absolute iron deficiency in maintenance haemodialysis patients is linked to higher coronary artery calcification and increased cardiovascular mortality. This study highlights iron status as a critical factor in vascular health for dialysis patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Hematology
Background:
- Clinical studies on iron's role in vascular calcification are limited, despite preclinical evidence.
- Vascular calcification and associated mortality are significant concerns in patients undergoing maintenance haemodialysis (MHD).
- Understanding iron status in MHD patients is crucial for managing cardiovascular risk.
Purpose of the Study:
- To investigate the association between absolute iron deficiency and coronary artery calcification (CACS) in MHD patients.
- To examine the relationship between absolute iron deficiency and 3-year mortality (all-cause and cardiovascular) in MHD patients.
- To identify iron deficiency markers as predictors of CACS and mortality in this population.
Main Methods:
- A cohort of 306 maintenance haemodialysis patients was studied.
- Baseline measurements included transferrin saturation (TSAT), ferritin, mean corpuscular haemoglobin (MCH), and Agatston coronary artery calcium score (CACS).
- Patients were followed for 3 years for mortality; Cox proportional hazard and linear regression analyses were performed.
Main Results:
- Patients with absolute iron deficiency (TSAT <20% and ferritin <100 ng/mL) exhibited significantly higher CACS and C-reactive protein levels.
- Absolute iron deficiency independently predicted 3-year cardiovascular mortality (HR: 2.08, p=0.0466) but not all-cause mortality.
- CACS, absolute iron deficiency, and MCH were significant predictors of CACS and mortality outcomes.
Conclusions:
- Absolute iron deficiency is associated with increased coronary artery calcification in MHD patients.
- Absolute iron deficiency serves as a significant risk factor for coronary artery calcification and 3-year cardiovascular mortality in MHD patients.
- Iron status, specifically absolute iron deficiency, should be considered in the cardiovascular risk assessment of MHD patients.
Aim:
The effects of iron on vascular calcification in rats and vascular smooth muscle cells were recently reported, but clinical studies on iron and vascular calcification are scant. We studied the associations of absolute iron deficiency, coronary artery calcification and mortality in patients with maintenance haemodialysis (MHD).
Methods:
Transferrin saturation (TSAT), ferritin, mean corpuscular haemoglobin (MCH) and Agatston coronary artery calcium score (CACS) were studied at baseline in MHD patients and followed up for 3 years. Cox proportional hazard analyses for mortality and linear regression analyses for CACS were performed.
Results:
In 306 patients, the median age was 67 (56-81) years, dialysis duration was 76 (38-142) months, and diabetes prevalence was 42.5%. Fifty-two patients had died by 3 years. Patients with absolute iron deficiency (TSAT <20% and ferritin <100 ng/mL) (n = 102) showed significantly higher CACS (p = .0266) and C-reactive protein (p = .0011), but a lower frequency of iron formulation administration compared with patients without absolute iron deficiency at baseline (n = 204). Absolute iron deficiency was a significant predictor for 3-year cardiovascular (CV) mortality (hazard ratio: 2.08; p = .0466), but not for 3-year all-cause mortality. CACS was significant predictor for both 3-year CV and all-cause mortality (p <.05). Absolute iron deficiency and MCH were significant determinants of CACS (p < .05).
Conclusion:
MHD patients with absolute iron deficiency showed significantly higher CACS than others, and absolute iron deficiency was a significant risk factor for coronary artery calcification and 3-year CV mortality in MHD patients, but was not a significant predictor for 3-year all-cause mortality.
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