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Iron Homeostasis at High Altitude in Patients With Pulmonary Hypertension
Aurelia E Reiser1, Markus Thiersch1, Max Gassmann1
1Institute of Veterinary Physiology Vetsuisse Faculty, University of Zürich Zurich Switzerland.
Pulmonary Circulation
|July 28, 2026
Summary
Iron deficiency worsens high-altitude effects in pulmonary hypertension (PH) patients. Transferrin levels predict oxygen saturation and carbon dioxide levels, identifying PH patients at risk for altitude-related complications.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Altitude Physiology
Background:
- Iron deficiency exacerbates hypoxic pulmonary vasoconstriction, increasing pulmonary arterial pressure at high altitude (HA).
- Pulmonary hypertension (PH) patients often have iron deficiency and may be susceptible to HA-related complications.
- No prior data existed on iron parameters and HA adaptation in PH patients.
Purpose of the Study:
- To investigate iron parameters and their impact on HA adaptation in PH patients.
- To determine if iron status influences physiological responses to high altitude in PH.
- To identify potential clinical markers for predicting HA-related risks in PH patients.
Main Methods:
- A randomized cross-over trial involving 27 PH patients (pulmonary arterial hypertension or chronic thromboembolic PH).
- Patients were assessed at baseline (470m) and during a stay at 2500m.
- Blood samples were analyzed for iron parameters (ferritin, transferrin, sTfR, hepcidin) and blood gases (PaCO2, SpO2) at both altitudes.
Main Results:
- High altitude exposure increased ferritin, transferrin, and soluble transferrin receptor (sTfR) levels, correlating with decreased hepcidin.
- Arterial partial pressure of carbon dioxide (PaCO2) was inversely correlated with transferrin levels.
- Low baseline transferrin (<30 µmol/L) predicted lower nocturnal oxygen saturation (SpO2) and identified patients needing oxygen at HA with 84% accuracy.
Conclusions:
- Transferrin levels are significantly altered by high altitude exposure in PH patients.
- Baseline transferrin concentration is an independent predictor of PaCO2 and SpO2 at both baseline and high altitude.
- Transferrin may serve as a valuable clinical marker to identify PH patients at risk of oxygen desaturation at high altitude.
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