Division of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan.
Department of Nephrology, Hiroshima University, Hiroshima, Japan.
Nephrology (Carlton). 2024 Jul;29(7):415-421. doi: 10.1111/nep.14289. Epub 2024 Mar 19.
The effects of iron on vascular calcification in rats and vascular smooth muscle cells were recently reported, but clinical studies on iron and vascular calcification are scant. We studied the associations of absolute iron deficiency, coronary artery calcification and mortality in patients with maintenance haemodialysis (MHD).
Transferrin saturation (TSAT), ferritin, mean corpuscular haemoglobin (MCH) and Agatston coronary artery calcium score (CACS) were studied at baseline in MHD patients and followed up for 3 years. Cox proportional hazard analyses for mortality and linear regression analyses for CACS were performed.
In 306 patients, the median age was 67 (56-81) years, dialysis duration was 76 (38-142) months, and diabetes prevalence was 42.5%. Fifty-two patients had died by 3 years. Patients with absolute iron deficiency (TSAT <20% and ferritin <100 ng/mL) (n = 102) showed significantly higher CACS (p = .0266) and C-reactive protein (p = .0011), but a lower frequency of iron formulation administration compared with patients without absolute iron deficiency at baseline (n = 204). Absolute iron deficiency was a significant predictor for 3-year cardiovascular (CV) mortality (hazard ratio: 2.08; p = .0466), but not for 3-year all-cause mortality. CACS was significant predictor for both 3-year CV and all-cause mortality (p <.05). Absolute iron deficiency and MCH were significant determinants of CACS (p < .05).
MHD patients with absolute iron deficiency showed significantly higher CACS than others, and absolute iron deficiency was a significant risk factor for coronary artery calcification and 3-year CV mortality in MHD patients, but was not a significant predictor for 3-year all-cause mortality.
最近有研究报道铁对大鼠血管钙化和血管平滑肌细胞的影响，但关于铁与血管钙化的临床研究较少。我们研究了维持性血液透析（MHD）患者的绝对缺铁、冠状动脉钙化和死亡率之间的关系。
在 MHD 患者的基线时检测转铁蛋白饱和度（TSAT）、铁蛋白、平均红细胞血红蛋白（MCH）和 Agatston 冠状动脉钙评分（CACS），并随访 3 年。采用 Cox 比例风险分析死亡率，采用线性回归分析 CACS。
在 306 例患者中，中位年龄为 67（56-81）岁，透析时间为 76（38-142）个月，糖尿病患病率为 42.5%。3 年内有 52 例患者死亡。与无绝对缺铁（TSAT <20%和铁蛋白 <100ng/mL）的患者（n=204）相比，绝对缺铁（TSAT <20%和铁蛋白 <100ng/mL）的患者（n=102）CACS（p=0.0266）和 C 反应蛋白（p=0.0011）更高，而铁制剂的应用频率更低。在基线时绝对缺铁是 3 年心血管（CV）死亡率的显著预测因素（危险比：2.08；p=0.0466），但不是 3 年全因死亡率的预测因素。CACS 是 3 年 CV 和全因死亡率的显著预测因素（p<.05）。绝对缺铁和 MCH 是 CACS 的显著决定因素（p<.05）。
与其他患者相比，MHD 患者的绝对缺铁明显更高，绝对缺铁是 MHD 患者冠状动脉钙化和 3 年 CV 死亡率的显著危险因素，但不是 3 年全因死亡率的显著预测因素。
