Association of Circulatory Iron Deficiency With an Enlarged Heart in Patients With End-Stage Kidney Disease

Toshihide Hayashi, Yuri Tanaka, Masaki Iwasaki, Hiroki Hase, Hiroyuki Yamamoto, Yasuhiro Komatsu, Ryoichi Ando, Masato Ikeda, Daijo Inaguma, Toshifumi Sakaguchi, Toshio Shinoda, Fumihiko Koiwa, Shigeo Negi, Toshihiko Yamaka, Takashi Shigematsu, Nobuhiko Joki

Research output: Contribution to journalArticle

Abstract

Objectives: High prevalence of iron deficiency (ID) and cardiomyopathy have been observed in patients with end-stage kidney disease (ESKD). Our objective was to clarify associations between ID and cardiac remodeling in patients with ESKD. Design and Methods: A cross-sectional study was conducted using 1974 Japanese patients with ESKD at the initiation of maintenance dialysis. Levels of hemoglobin (Hb), iron status, and cardiac enlargement as assessed by the cardiothoracic ratio (CTR) were determined immediately before the first hemodialysis session. Circulatory ID was defined as transferrin saturation (TSAT) < 20%, and stored ID was defined as ferritin level <100 ng/dL. Results: The mean age was 67 years. Median CTR was 54.0%. The prevalence of circulatory and stored ID was found to be 38% and 34%, respectively. CTR was higher in patients with circulatory ID than in those without. Even in ESKD patients without overhydration, significant negative association was observed between TSAT and CTR. Higher odds ratios in parallel with higher CTR categories compared with the reference category of CTR <45% were found in patients with TSAT <20% on multinomial analysis, but ferritin did not show any significant associations. The odds ratio for CTR >54% showed an upward trend in patients with TSAT <20% (odds ratio: 1.3) and <10% (odds ratio: 1.6) compared with the reference, even after adjusting for confounding variables such as Hb and ferritin. However, that phenomenon was eliminated by adding usage of an iron agent. Conclusions: Circulatory ID is closely associated with an enlarged heart independent of ferritin and Hb. Iron supplementation in the predialysis phase of chronic kidney disease may prevent cardiac remodeling independent of Hb level in patients chronic kidney disease.

Original languageEnglish
Pages (from-to)39-47
Number of pages9
JournalJournal of Renal Nutrition
Volume29
Issue number1
DOIs
Publication statusPublished - 01-01-2019

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Cardiomegaly
Chronic Kidney Failure
Iron
Hemoglobins
Transferrin
Ferritins
Chronic Renal Insufficiency
Odds Ratio
Confounding Factors (Epidemiology)
Cardiomyopathies
Renal Dialysis
Dialysis
Cross-Sectional Studies
Maintenance

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics
  • Nephrology

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Hayashi, Toshihide ; Tanaka, Yuri ; Iwasaki, Masaki ; Hase, Hiroki ; Yamamoto, Hiroyuki ; Komatsu, Yasuhiro ; Ando, Ryoichi ; Ikeda, Masato ; Inaguma, Daijo ; Sakaguchi, Toshifumi ; Shinoda, Toshio ; Koiwa, Fumihiko ; Negi, Shigeo ; Yamaka, Toshihiko ; Shigematsu, Takashi ; Joki, Nobuhiko. / Association of Circulatory Iron Deficiency With an Enlarged Heart in Patients With End-Stage Kidney Disease. In: Journal of Renal Nutrition. 2019 ; Vol. 29, No. 1. pp. 39-47.
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title = "Association of Circulatory Iron Deficiency With an Enlarged Heart in Patients With End-Stage Kidney Disease",
abstract = "Objectives: High prevalence of iron deficiency (ID) and cardiomyopathy have been observed in patients with end-stage kidney disease (ESKD). Our objective was to clarify associations between ID and cardiac remodeling in patients with ESKD. Design and Methods: A cross-sectional study was conducted using 1974 Japanese patients with ESKD at the initiation of maintenance dialysis. Levels of hemoglobin (Hb), iron status, and cardiac enlargement as assessed by the cardiothoracic ratio (CTR) were determined immediately before the first hemodialysis session. Circulatory ID was defined as transferrin saturation (TSAT) < 20{\%}, and stored ID was defined as ferritin level <100 ng/dL. Results: The mean age was 67 years. Median CTR was 54.0{\%}. The prevalence of circulatory and stored ID was found to be 38{\%} and 34{\%}, respectively. CTR was higher in patients with circulatory ID than in those without. Even in ESKD patients without overhydration, significant negative association was observed between TSAT and CTR. Higher odds ratios in parallel with higher CTR categories compared with the reference category of CTR <45{\%} were found in patients with TSAT <20{\%} on multinomial analysis, but ferritin did not show any significant associations. The odds ratio for CTR >54{\%} showed an upward trend in patients with TSAT <20{\%} (odds ratio: 1.3) and <10{\%} (odds ratio: 1.6) compared with the reference, even after adjusting for confounding variables such as Hb and ferritin. However, that phenomenon was eliminated by adding usage of an iron agent. Conclusions: Circulatory ID is closely associated with an enlarged heart independent of ferritin and Hb. Iron supplementation in the predialysis phase of chronic kidney disease may prevent cardiac remodeling independent of Hb level in patients chronic kidney disease.",
author = "Toshihide Hayashi and Yuri Tanaka and Masaki Iwasaki and Hiroki Hase and Hiroyuki Yamamoto and Yasuhiro Komatsu and Ryoichi Ando and Masato Ikeda and Daijo Inaguma and Toshifumi Sakaguchi and Toshio Shinoda and Fumihiko Koiwa and Shigeo Negi and Toshihiko Yamaka and Takashi Shigematsu and Nobuhiko Joki",
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Hayashi, T, Tanaka, Y, Iwasaki, M, Hase, H, Yamamoto, H, Komatsu, Y, Ando, R, Ikeda, M, Inaguma, D, Sakaguchi, T, Shinoda, T, Koiwa, F, Negi, S, Yamaka, T, Shigematsu, T & Joki, N 2019, 'Association of Circulatory Iron Deficiency With an Enlarged Heart in Patients With End-Stage Kidney Disease' Journal of Renal Nutrition, vol. 29, no. 1, pp. 39-47. https://doi.org/10.1053/j.jrn.2018.05.004

Association of Circulatory Iron Deficiency With an Enlarged Heart in Patients With End-Stage Kidney Disease. / Hayashi, Toshihide; Tanaka, Yuri; Iwasaki, Masaki; Hase, Hiroki; Yamamoto, Hiroyuki; Komatsu, Yasuhiro; Ando, Ryoichi; Ikeda, Masato; Inaguma, Daijo; Sakaguchi, Toshifumi; Shinoda, Toshio; Koiwa, Fumihiko; Negi, Shigeo; Yamaka, Toshihiko; Shigematsu, Takashi; Joki, Nobuhiko.

In: Journal of Renal Nutrition, Vol. 29, No. 1, 01.01.2019, p. 39-47.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association of Circulatory Iron Deficiency With an Enlarged Heart in Patients With End-Stage Kidney Disease

AU - Hayashi, Toshihide

AU - Tanaka, Yuri

AU - Iwasaki, Masaki

AU - Hase, Hiroki

AU - Yamamoto, Hiroyuki

AU - Komatsu, Yasuhiro

AU - Ando, Ryoichi

AU - Ikeda, Masato

AU - Inaguma, Daijo

AU - Sakaguchi, Toshifumi

AU - Shinoda, Toshio

AU - Koiwa, Fumihiko

AU - Negi, Shigeo

AU - Yamaka, Toshihiko

AU - Shigematsu, Takashi

AU - Joki, Nobuhiko

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: High prevalence of iron deficiency (ID) and cardiomyopathy have been observed in patients with end-stage kidney disease (ESKD). Our objective was to clarify associations between ID and cardiac remodeling in patients with ESKD. Design and Methods: A cross-sectional study was conducted using 1974 Japanese patients with ESKD at the initiation of maintenance dialysis. Levels of hemoglobin (Hb), iron status, and cardiac enlargement as assessed by the cardiothoracic ratio (CTR) were determined immediately before the first hemodialysis session. Circulatory ID was defined as transferrin saturation (TSAT) < 20%, and stored ID was defined as ferritin level <100 ng/dL. Results: The mean age was 67 years. Median CTR was 54.0%. The prevalence of circulatory and stored ID was found to be 38% and 34%, respectively. CTR was higher in patients with circulatory ID than in those without. Even in ESKD patients without overhydration, significant negative association was observed between TSAT and CTR. Higher odds ratios in parallel with higher CTR categories compared with the reference category of CTR <45% were found in patients with TSAT <20% on multinomial analysis, but ferritin did not show any significant associations. The odds ratio for CTR >54% showed an upward trend in patients with TSAT <20% (odds ratio: 1.3) and <10% (odds ratio: 1.6) compared with the reference, even after adjusting for confounding variables such as Hb and ferritin. However, that phenomenon was eliminated by adding usage of an iron agent. Conclusions: Circulatory ID is closely associated with an enlarged heart independent of ferritin and Hb. Iron supplementation in the predialysis phase of chronic kidney disease may prevent cardiac remodeling independent of Hb level in patients chronic kidney disease.

AB - Objectives: High prevalence of iron deficiency (ID) and cardiomyopathy have been observed in patients with end-stage kidney disease (ESKD). Our objective was to clarify associations between ID and cardiac remodeling in patients with ESKD. Design and Methods: A cross-sectional study was conducted using 1974 Japanese patients with ESKD at the initiation of maintenance dialysis. Levels of hemoglobin (Hb), iron status, and cardiac enlargement as assessed by the cardiothoracic ratio (CTR) were determined immediately before the first hemodialysis session. Circulatory ID was defined as transferrin saturation (TSAT) < 20%, and stored ID was defined as ferritin level <100 ng/dL. Results: The mean age was 67 years. Median CTR was 54.0%. The prevalence of circulatory and stored ID was found to be 38% and 34%, respectively. CTR was higher in patients with circulatory ID than in those without. Even in ESKD patients without overhydration, significant negative association was observed between TSAT and CTR. Higher odds ratios in parallel with higher CTR categories compared with the reference category of CTR <45% were found in patients with TSAT <20% on multinomial analysis, but ferritin did not show any significant associations. The odds ratio for CTR >54% showed an upward trend in patients with TSAT <20% (odds ratio: 1.3) and <10% (odds ratio: 1.6) compared with the reference, even after adjusting for confounding variables such as Hb and ferritin. However, that phenomenon was eliminated by adding usage of an iron agent. Conclusions: Circulatory ID is closely associated with an enlarged heart independent of ferritin and Hb. Iron supplementation in the predialysis phase of chronic kidney disease may prevent cardiac remodeling independent of Hb level in patients chronic kidney disease.

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