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Abstract: TH-PO701

Adverse Additive Effect of Iron Deficiency on Cardiac Death in Incident Hemodialysis Patients With Left Ventricular Systolic Dysfunction

Session Information

  • Anemia and Iron Metabolism
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism

Authors

  • Hitaka, Mai, Department of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
  • Nakata, Kenji, Department of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
  • Hayashi, Toshihide, Department of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
  • Harada, Minako, Department of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
  • Yamamura, Ayaka, Department of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
  • Ohashi, Yasushi, Department of Nephrology, Toho University Sakura Medical Center, Chiba, Japan
  • Tanaka, Yuri, Department of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
  • Joki, Nobuhiko, Department of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
Background

Iron deficiency (ID), especially low transferrin saturation (TSAT), has a great impact on cardiac events in patients with heart failure (HF) reduced ejection fraction. Our previous study has shown low TSAT is closely associated with an enlarged heart, independent of hemoglobin level in incident hemodialysis (HD) patients. The purpose of this study is to examine the adverse effect of ID depending on the cardiac functional status.

Methods

705 patients with iron data were included in this study, out of 809 consecutive end-stage kidney disease(ESKD) patients who started maintenance HD therapy during January 1993 and December 2021. The primary endpoint was defined as cardiac death including death of myocardial infarction, HF and sudden death. ID was defined as TSAT<20% regardless of the ferritin level. 5-year cumulative survival rate was calculated by Kaplan Meier curve in 4 ESKD patient groups with/without ID and with/without ejection fraction (EF) <50%. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated by Cox proportional hazard model.

Results

Mean age was 68 years, 30% female. During the mean follow-up period of 3.0 ± 1.9 years, 188 deaths occurred, 46 of which were cardiac deaths. About 16% and 40% of patients suffered from ID and EF<50% respectively at the initiation of HD. 5-year survival rate was 93.9% in non-ID group, which is significantly higher than that of ID group of 83.4%. Lower survival rate of 74.3% was found in ID with EF<50% group compared to 86.5% of non-ID with EF<50% group. As shown in the table, Cox regression analysis revealed that in patients with low-EF, HR is showing abrupt increment from 2.3 to 7.4 when combined with ID.

Conclusion

The additive adverse effect of ID on cardiac death was indicated in incident HD patients with left ventricular systolic dysfunction. Further study is needed to confirm the effect of iron supplementation for better prognosis in maintenance HD patients with cardiac dysfunction.

 HR95% CIp
Non-ID/EF≧50%1  
Non-ID/EF<50%2.30.72-7.390.1585
ID/ EF≧50%3.11.44-6.740.0037
ID/ EF<50%7.42.97-18.44<0.0001

Adjusted by age, gender, diabetes mellitus, and hemoglobin.