Chronic Kidney Disease (CKD) and Heart Failure (HF)are commonly coexistent conditions and both share common risk factors and comorbidities. In a recent study, researchers have found iron deficiency as an independent risk factor for heart failure hospitalization in patients with CKD. The study findings were published in the Clinical Journal of the American Society of Nephrology on March 29, 2021.
Iron deficiency anaemia (IDA) remains amongst the five leading causes of years lived with disability in humans and the top cause in women. Myocardial iron content has been shown to be lower in HF, measured by magnetic resonance imaging (MRI)4 as well as in samples of the left ventricle of the human heart. Previous studies have reported that iron dysmetabolism potentially contributes to heart failure, but this relationship has not been well characterized in CKD. Therefore, researchers of Monique E. Cho, MD, of the Veterans Affairs Salt Lake City Health Care System and the University of Utah in Salt Lake City, and colleagues conducted a study to evaluate the association between serum iron indices and heart failure hospitalization in the CKD population.
It was a historical cohort study using data from the Veterans Affairs Corporate Data Warehouse to evaluate the relationship between iron status and heart failure hospitalization. The researchers identified a CKD cohort with at least one set of iron indices between 2006 and 2015. The researchers analyzed data from 78,551 veterans with CKD whom they divided into 4 iron groups according to joint quartiles of serum transferrin saturation (TSAT) and ferritin. It includes:
Reference (16%–28%, 55–205 ng/ml),
Low iron (0.4%–16%, 0.9–55 ng/ml),
High iron (28%–99.5%, 205–4941 ng/ml), and
Function iron deficiency (0.8%–16%, 109–2783 ng/ml).
They used matching weights derived from multinomial propensity score models and Poisson rate-based regression to compare 1-year heart failure hospitalization risk between the iron groups.
Key findings of the study were:
Upon analysis, the researchers found that the one-year adjusted relative rate for heart failure hospitalization in the iron deficiency groups was higher compared with the reference group (low iron: 1.29; functional iron deficiency: 1.25).
They noted that patients in the high-iron group had a lower 1-year relative rate of heart failure hospitalization (0.82).
They also noted that the association between iron deficiency and heart failure hospitalization risk remained consistent regardless of the diabetes status or heart failure history at baseline.
The authors concluded, "Iron deficiency, regardless of cause, was associated with higher heart failure hospitalization risk in CKD. Higher iron status was associated with lower heart failure hospitalization risks."
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