Myocardial Iron Deficiency in Hemodialysis-Dependent End-Stage Renal Disease Patients Undergoing Oral Iron Therapy

Xu, Huayan; Yang, Zhi-gang; Li, Rui; Shi, Ke; Zhang, Yi; Li, Zhenlin; Xia, Chunchao; Peng, Wanlin; Chen, Qingyong; Guo, Ying

doi:10.1016/j.jacc.2017.09.013

Cited by 7 publications

(9 citation statements)

References 5 publications

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“…In contrast, we found that a serum ferritin level <300 ng/mL was associated with higher risks of all‐cause and cardiovascular mortality. Iimori et al22 demonstrated that iron‐deficiency anemia was associated with all‐cause mortality in patients with CKD, and Xu et al23 further reported that myocardial iron depletion was associated with left ventricular dysfunction. These findings22, 23 are corroborated by our observations.…”

Section: Discussionmentioning

confidence: 99%

“…Iimori et al22 demonstrated that iron‐deficiency anemia was associated with all‐cause mortality in patients with CKD, and Xu et al23 further reported that myocardial iron depletion was associated with left ventricular dysfunction. These findings22, 23 are corroborated by our observations. Galić et al24 reported that the incidences of sepsis and vascular access infection were higher among patients undergoing hemodialysis with a serum ferritin level >500 ng/mL.…”

Section: Discussionmentioning

confidence: 99%

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Association of Anemia and Iron Parameters With Mortality Among Patients Undergoing Prevalent Hemodialysis in Taiwan: The AIM‐HD Study

Kuo

Hung

Tseng

et al. 2018

JAHA

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BackgroundThe Taiwan Health Insurance Bureau has conducted a bundled payment system for hemodialysis reimbursement since 1995. The maximum dose of erythropoiesis‐stimulating agents allowed by insurance is capped at 20 000 U of epoetin or 100 μg of darbepoetin alfa per month. Nephrologists have avoided the use of high dosages of erythropoiesis‐stimulating agents to achieve a hemoglobin level of 10 to 11 g/dL by iron supplementation. The clinical impact of these policies on patients’ outcomes is unknown. The authors aimed to assess the AIM‐HD (Association of Anemia, Iron parameters, and Mortality among the prevalent Hemodialysis patients) Study in Taiwan.Methods and ResultsThe AIM‐HD study was conducted based on the Taiwan Renal Registry Data System. From 2001 to 2008, the authors enrolled 42 230 patients undergoing hemodialysis who were older than 20 years and had received hemodialysis for more than 12 months. Patient follow‐ups occurred until death or December 31, 2008. During a study period of 8 years, 12 653 (30.0%) patients died. After multivariate adjustment, the authors found that a hemoglobin level <10 g/dL was significantly associated with higher risk for all‐cause and cardiovascular deaths. Moreover, a serum ferritin level between 300 and 800 ng/mL and transferrin saturation value between 30% and 50% were associated with the lowest all‐cause mortality.ConclusionsThe authors recommend avoiding a low hemoglobin level and maintaining serum ferritin between 300 and 800 ng/mL and transferrin saturation between 30% and 50%, which were associated with lower risks of all‐cause mortality among patients undergoing hemodialysis receiving the restricted erythropoiesis‐stimulating agent doses but prompt intravenous iron supplementation in Taiwan.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of Anemia and Iron Parameters With Mortality Among Patients Undergoing Prevalent Hemodialysis in Taiwan: The AIM‐HD Study

Kuo

Hung

Tseng

et al. 2018

JAHA

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“…[ 34 ] Indeed, animal models of iron deficiency (induced by either knockout or with low iron diets) show progressive cardiac remodelling consisting of ventricular dilatation, ventricular hypertrophy, systolic dysfunction and cardiomyocyte apoptosis thereby implicating iron in the process of progressive cardiac remodelling. [ 35 , 36 ] In humans, an approach that also clearly documented the involvement of iron deficiency on cardiac remodelling was shown by studying the modulating role of iron deficiency on cardiac reverse remodelling after CRT implant. CRT as a non-pharmacological treatment option for HFrEF patients with electromechanical dyssynchrony can be seen as a clean model allowing a way to study the influences of a covariate on the process of reverse remodelling.…”

Section: The Impact Of Iron Deficiency On Cardiac Structurementioning

confidence: 99%

The Effect of Iron Deficiency on Cardiac Function and Structure in Heart Failure with Reduced Ejection Fraction

Martens

2022

Card Fail Rev

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Over the past decade, the detrimental impact of iron deficiency in heart failure with reduced ejection fraction has become abundantly clear, showing a negative impact on functional status, quality of life, cardiac function and structure, exercise capacity and an increased risk of hospitalisation due to heart failure. Mechanistic studies have shown the impact of iron deficiency in altering mitochondrial function and negatively affecting the already altered cardiac energetics in heart failure with reduced ejection fraction. Such failing energetics form the basis of the alterations to cellular myocyte shortening, culminating in reduced systolic function and cardiac performance. The IRON-CRT trials show that ferric carboxymaltose is capable of improving cardiac structure and cardiac performance. This article discusses the effect of iron deficiency on cardiac function and structure and how it can be alleviated.

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“…In an in vitro human cardiomyocytes experiment, when human embryonic stem cell-derived cardiomyocytes were deprived of iron, cardiomyocyte function was reduced as characterized by impaired mitochondrial respiration and reduced contractility and relaxation (29). In other studies, on the basis of T2* CMR (16, 17, 30-32), elevated myocardial T2* values (hence reduced iron content) has been shown to occur in non-ischemic heart failure (16, 32), hypertrophic cardiomyopathy (31), and hemodialysisdependent end-stage renal disease (ESRD) (17,30). Increased T2* has also been shown to be a an independent risk factor for LV dysfunction in ESRD patients (17) and a predictor of adverse cardiac events in non-ischemic heart failure (16).…”

Section: Discussionmentioning

confidence: 99%

“…Studies have also shown that changes in iron within the myocardium to be highly correlated with intramyocardial hemorrhage in ischemic heart disease ( 15 ). However, only a limited number of studies have reported utilized T2* CMR for ID in non-ischemic cardiomyopathies ( 16 , 17 ). Notably, the assessment of myocardial iron content in patients using CMR has not been reported in HIV-1-infected patients.…”

Section: Introductionmentioning

confidence: 99%

Association of myocardial iron deficiency based on T2* CMR with the risk of mild left ventricular dysfunction in HIV-1-infected patients

Yan

Zhang

et al. 2023

Front. Cardiovasc. Med.

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ObjectivesThis study sought to noninvasively determine myocardial iron levels in HIV-1-infected patients using CMR and explore the association between T2* values and mild left ventricular systolic dysfunction (LVSD).MethodsThis prospective study was conducted from June 2019 to July 2021. HIV-1-infected adults and healthy controls were consecutively enrolled for CMR exam. CMR exam included the assessment of myocardium iron content (T2*), cardiac function (cine), inflammation (T2), and fibrosis (through extracellular volume fraction [ECV] and late gadolinium enhancement [LGE]) measurements. Mild LVSD is defined as a left ventricular ejection fraction (LVEF) between 40% and 49%.ResultsOf 47 HIV-1-infected patients enrolled, 12 were diagnosed with mild LVSD (HIV-1+/LEVF+) and 35 were diagnosed with preserved LV function (HIV-1+/LEVF−). Compared with healthy controls, HIV-1-infected patients displayed higher T2*, T1, T2, ECV values and lower global circumferential strain (GCS) and global radial strain (GRS) (all P < 0.05). However, between patients with and without mild LVSD, only the T2* values and ECV (all P <0.05) were different. The association between increased T2* values (>26 ms) and mild LVSD remained significant after adjusting for the established univariate predictors (ECV >32.9%, T1 values >1336 ms) of mild LVSD (odds ratio [OR], 10.153; 95% confidence interval [CI] 1.565–65.878, P = 0.015).ConclusionsMyocardial T2* values were elevated in HIV-1-infected patients, supporting the notion that ID was associated with mild LVSD. Our findings highlight the potential for ID in HIV-1-infected patients as an auxiliary biomarker to monitor the course of LVSD.

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Myocardial Iron Deficiency in Hemodialysis-Dependent End-Stage Renal Disease Patients Undergoing Oral Iron Therapy

Cited by 7 publications

References 5 publications

Association of Anemia and Iron Parameters With Mortality Among Patients Undergoing Prevalent Hemodialysis in Taiwan: The AIM‐HD Study

Association of Anemia and Iron Parameters With Mortality Among Patients Undergoing Prevalent Hemodialysis in Taiwan: The AIM‐HD Study

The Effect of Iron Deficiency on Cardiac Function and Structure in Heart Failure with Reduced Ejection Fraction

Association of myocardial iron deficiency based on T2* CMR with the risk of mild left ventricular dysfunction in HIV-1-infected patients

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