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Abstract: PO1226

Association Among Iron, Coronary Artery Calcification, and Mortality in Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Mizuiri, Sonoo, Ichiyokai Harada Hospital, Hiroshima, Japan
  • Nishizawa, Yoshiko, Ichiyokai Harada Hospital, Hiroshima, Japan
  • Doi, Toshiki, Hiroshima University Hospital, Hiroshima, Japan
  • Yamashita, Kazuomi, Ichiyokai Harada Hospital, Hiroshima, Japan
  • Shigemoto, Kenichiro, Ichiyokai Harada Hospital, Hiroshima, Japan
  • Usui, Kohji, Ichiyokai Ichiyokai Clinic, Hiroshima, Japan
  • Doi, Shigehiro, Hiroshima University Hospital, Hiroshima, Japan
  • Masaki, Takao, Hiroshima University Hospital, Hiroshima, Japan

Group or Team Name

  • Ichiyokai, Hiroshima, Japan

Coronary artery calcification (CAC) is recognized as one of the main causes of cardiovascular disease and death in hemodialysis (HD) patients. It had been suggested that iron may be related to vascular calcification (Balla et al. Pharmaceuticals. 2019;12:96). This study aimed to investigate the association among iron, CAC, and mortality in HD patients.


This study included 173 HD patients. Clinical data and Agatston’s coronary artery calcification score (CACS) were obtained at baseline. Two groups comprised patients with CACS ≥400 (n=109) and patients with CACS <400 (n=64). Logistic regression analyses for CACS ≥400 and Kaplan-Meier survival and Cox proportional hazard analyses were conducted.


The median (interquartile range) age and dialysis vintage among all subjects were 67 (60–75) years and 73 (37–138) months, respectively. Serum iron (Fe) and transferrin saturation (TSAT) levels were significantly lower, but age, dialysis vintage, C-reactive protein (CRP), and albumin-adjusted serum calcium (Ca) levels were significantly higher in patients with CACS ≥400 than in patients with CACS <400 (P<0.05). No significant differences in the dosage of phosphate binders, active vitamin D, cinacalcet, and iron were observed. In the univariate logistic regression analysis, CACS ≥400 had a significant association with TSAT ≥20%, Fe ≥80 µg/dL, age, and dialysis vintage (P<0.05). In the subsequent multivariate analysis, including all variables that showed significance in the univariate analysis, excluding Fe ≥80 µg/dL, and well-known risk factors for coronary artery calcification in HD patients (diabetes mellitus, Ca, phosphate, and CRP), TSAT ≥20% remained independently and significantly associated with CACS ≥400 (odds ratio 0.44, P<0.05). HD patients with Fe ≥80 µg/dL showed significantly higher 5-year survival. However, patients with serum ferritin ≥36.6 ng/mL (median ferritin value in this study) showed significantly lower 5-year survival than patients with ferritin <36.6 ng/mL, and ferritin ≥36.6 ng/mL was a significant predictor of 5-year all-cause mortality in HD patients (hazard ratio: 2.71, P<0.05).


In HD patients, there is an association among iron, CAC, and mortality, and TSAT ≥20% was found to be an independent and significant factor in the prevention of CACS ≥400.


  • Private Foundation Support