Iron, coronary artery calcification, and mortality in patients undergoing hemodialysis

Abstract

Objective: A high coronary artery calcification score (CACS) may be associated with high mortality in patients undergoing hemodialysis (HD). Recently, effects of iron on vascular smooth muscle cell calcification have been described. We aimed to investigate the relationships between iron, CACS, and mortality in HD patients. Methods: We studied 173 consecutive patients who were undergoing maintenance HD. Laboratory data and Agatston's CACS were obtained at baseline for two groups of patients: those with CACS !400 (n ¼ 109) and those with CACS <400 (n ¼ 64). Logistic regression analyses for CACS !400 and Cox proportional hazard analyses for mortality were conducted. Results: The median (interquartile range) age and duration of dialysis of the participants were 67 (60-75) years and 73 (37-138) months, respectively. Serum iron (Fe) and transferrin saturation (TSAT) levels were significantly lower in participants with CACS !400 than in those with CACS <400, although the serum ferritin concentration did not differ between the groups. TSAT !21% was significantly associated with CACS !400 (odds ratio 0.46, p<0.05). TSAT !17%, Fe !63 mg/ dL, and ferritin !200 ng/mL appear to protect against 5-year all-cause mortality in HD patients, independent of conventional risk factors of all-cause mortality (p < 0.05). Conclusion:We have identified associations between iron, CACS, and mortality in HD patients. Lower TSAT was found to be an independent predictor of CACS !400, and iron deficiency (low TSAT, iron, or ferritin) was a significant predictor of 5-year all-cause mortality in HD patients.

Effect of iron overload on endothelial cell calcification and its mechanism

“…Many previous studies found that iron was closely related to vascular calcification (9). However, the results of the research are not consistent and may be related to different research settings (10).…”

Peer Review #2 of "Association between fibrinogen/albumin ratio and severity of coronary artery calcification in patients with chronic kidney disease: a retrospective study (v0.1)"

“…Our findings are consistent with those of other researchers. Mizuiri et al (Mizuiri et al, 2021) PeerJ reviewing PDF | (2021:09:65335:3:0:NEW 13 May 2022)…”

Impact of Transferrin Saturation and Anemia on Radial Artery Calcification in Patients with End-Stage Kidney Disease

“…Anemia caused by erythropoiesis-stimulating agent hyporesponsiveness is associated with a higher risk of all-cause mortality in ESKD patients as well [ 23 , 24 ]. Therefore, these findings suggest that anemia, arterial calcification, and mortality are associated with ESKD patients [ 25 ]. However, excessive iron intake induces reactive oxygen species formation and promotes the local formation of oxidized LDL and arteriosclerosis through the induction of macrophages; caution should be exercised in iron supplementation.…”