Division of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan.
Department of Nephrology, Hiroshima University Hospital, Hiroshima, Japan.
Ren Fail. 2021 Dec;43(1):371-380. doi: 10.1080/0886022X.2021.1880937.
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.
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 ( = 109) and those with CACS <400 ( = 64). Logistic regression analyses for CACS ≥400 and Cox proportional hazard analyses for mortality were conducted.
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, 0.05). TSAT ≥17%, Fe ≥63 µg/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 ( < 0.05).
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.
高冠状动脉钙化评分（CACS）可能与接受血液透析（HD）的患者死亡率升高相关。最近，铁对血管平滑肌细胞钙化的影响已被描述。我们旨在研究铁、CACS 和 HD 患者死亡率之间的关系。
我们研究了 173 例连续接受维持性 HD 的患者。在两组患者中，基线时获得了实验室数据和 Agatston 的 CACS：CACS≥400（n=109）和 CACS<400（n=64）。对 CACS≥400 进行逻辑回归分析，对死亡率进行 Cox 比例风险分析。
参与者的中位（四分位间距）年龄和透析时间分别为 67（60-75）岁和 73（37-138）个月。CACS≥400 的参与者的血清铁（Fe）和转铁蛋白饱和度（TSAT）水平明显低于 CACS<400 的参与者，尽管两组之间的血清铁蛋白浓度没有差异。TSAT≥21%与 CACS≥400 显著相关（优势比 0.46，0.05）。TSAT≥17%、Fe≥63µg/dL 和铁蛋白≥200ng/mL 似乎可以保护 HD 患者免受 5 年全因死亡率的影响，独立于全因死亡率的常规危险因素（<0.05）。
我们确定了 HD 患者中铁、CACS 和死亡率之间的关系。较低的 TSAT 被发现是 CACS≥400 的独立预测因子，铁缺乏（低 TSAT、铁或铁蛋白）是 HD 患者 5 年全因死亡率的显著预测因子。
