Iron deficiency is independently associated with a higher risk for heart failure hospitalization in patients with chronic kidney disease (CKD), whereas higher iron status is associated with a lower risk, according to a recent study.

The study is the largest to date to evaluate the association between serum iron indices and heart failure hospitalization in the CKD population, according to Monique E. Cho, MD, of the Veterans Affairs Salt Lake City Health Care System and the University of Utah in Salt Lake City, and colleagues.

“Our results have important implications for the current iron management in CKD, which focuses primarily on achieving target hemoglobin levels without giving much attention to the effects of iron on other organs,” Dr Cho’s team concluded in the Clinical Journal of the American Society of Nephrology. “Early detection of iron status may improve cardiovascular risk assessment and potentially allow optimization of modifiable risk factors in CKD.”

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The investigators analyzed data from 78,551 veterans with CKD whom they divided into 4 iron groups according to joint quartiles of serum transferrin saturation (TSAT) and ferritin.

Compared with patients who had TSAT values of 16%-28% and ferritin values of 55-205 ng/mL (reference group), those with low iron (TSAT 0.4%-16%, ferritin 0.9-55 ng/mL) and functional iron deficiency (TSAT 0.8%-16%, ferritin 109-2783 ng/mL) had significant 29% and 25% increased 1-year adjusted relative rates of heart failure hospitalization. Patients with high iron (TSAT 28%-99.5%, ferritin 205-4941 ng/mL) had a significant adjusted 18% lower relative rate.

The adjusted incidence rates of heart failure hospitalization per 100 person-years was 5.1 for the reference group compared with 6.5, 4.1, and 6.3 for the low iron, high iron, and functional iron deficiency groups, respectively.

“An important observation from this study is that both types of iron deficiency are associated with higher risk for heart failure hospitalization, whereas higher iron indices are associated with lower subsequent heart failure risk,” Dr Cho and colleagues stated.


Cho ME, Hansen JL, Sauer BC, Cheung AK, Agarwal A, Greene T. Heart failure hospitalization risk associated with iron status in veterans with CKD. Published online March 29, 2021. Clin J Am Soc Nephrol. doi:10.2215/CJN.15360920