Abstract: FR-PO261
Developing Iron Thresholds to Predict Heart Failure Hospitalization Risk in Veterans with CKD
Session Information
- CKD: Epidemiology and Risk Factors
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Cho, Monique E., George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, United States
- Hansen, Jared, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, United States
- Sauer, Brian C., George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, United States
- Cheung, Alfred K., George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, United States
- Greene, Tom, University of Utah, Salt Lake City, Utah, United States
Background
Iron deficiency is closely associated with heart failure (HF) risk. The specific thresholds for serum transferrin saturation (Tsat) or ferritin associated with HF are unknown in CKD.
Methods
We developed a historical cohort using the Veterans Affairs Informatics and Computing Infrastructure. We identified Veterans with pre-dialysis CKD (MDRD eGFR <60 mL/min/1.73m2) with at least one set of iron indices between 2006-2015. Veterans with ESRD, genetic or chronic disorders affecting iron metabolism, or those who received intravenous iron or erythropoietin stimulating agents within 3 months of the iron indices were excluded. A generalized additive Cox model was applied to the cohort to explore the joint dose-response relationship of the hazard for HF hospitalization following the iron assay. A full 3-D response surface relating the HF covariate-adjusted hazard to both Tsat and ferritin was developed using cubic regression splines.
Results
Of the 1,159,371 Veterans with CKD, 141,477 met the inclusion criteria. The mean±SD for age and eGFR were 72±11 years and 43±11 mL/min/1.73 m2, respectively. The median (IQR) Tsat and ferritin values were 22 (16, 28)% and 109 (55, 205) ng/mL. At the median values of Tsat and ferritin, 1-year cumulative incidence of HF hospitalization was 2.3%. Compared to the median value, Tsat ≤16% was associated with 25% increased risk for HF hospitalization while no specific threshold could be identified for ferritin. Tsat values ≤13% and ≤9% were associated with 50% and 100% increased risk of HF hospitalization at one year, respectively.
Conclusion
In Veterans with pre-dialysis CKD, decreased Tsat is closely associated with HF hospitalization risk, while serum ferritin levels do not provide a predictive value.
Figure. One-year cumulative incidence of HF hospitalization
Funding
- Veterans Affairs Support