Iron therapy might benefit patients with chronic kidney disease, even without anemia

Reuters Health - 13/07/2021 - Iron deficiency (ID), with or without anemia, is associated with a higher risk of death and cardiovascular events in patients with nondialysis chronic kidney disease (ND-CKD), according to new findings.

"This study provides observational support to the hypothesis that ID, regardless of anemia status, may affect clinical outcomes in patients with ND-CKD," researchers write in the Journal of the American Society of Nephrology.

Boosting iron levels in patients with heart failure and ID has been shown to improve cardiovascular health regardless of whether patients have anemia, Dr. Murilo Guedes, with the Arbor Research Collaborative for Health in Ann Arbor, Michigan, and colleagues note in their paper.

To evaluate a possible anemia-independent association of iron stores with outcomes in individuals with ND-CKD, they studied 5,145 ND-CKD patients enrolled in the observational Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps).

During three years of follow-up, low transferrin saturation (TSAT) levels were associated with an increase in the risk of all-cause mortality and incidence of major cardiovascular events (MACE), an effect that was not modified by the presence of anemia.

Compared with patients with a TSAT of 26% to 35%, those with a TSAT at or below 15% had the highest adjusted risks for all-cause mortality and MACE, the researchers report.

The lowest risk for death and MACE were in patients with TSAT of 40%. The risk of all-cause mortality, but not MACE, was also elevated at a TSAT level of 46% or higher.

"Additionally, patients with low TSAT simultaneous to high ferritin displayed the highest risk of adverse clinical events," the team writes.

"Long overdue in the ND-CKD setting, well-designed RCTs are needed to assess the clinical benefits of iron supplementation for patients with ID, with or without anemia, and therefore confirm the results provided in this study," they say.

"Proactive iron interventions, particularly IV iron, may lead to better tissue iron delivery and therefore better outcomes. With the shift in the paradigm in the anemia treatment provided by the approval of the novel class of hypoxia-inducible factor prolyl hydroxylase inhibitors, which, among other effects, improve iron availability, an integrative approach considering both iron status and hemoglobin may yield important benefits for ND-CKD individuals," they conclude.

This work was supported by Vifor-Fresenius Medical Care Renal Pharma Ltd. A complete list of author disclosures is available with the original article.

SOURCE: https://bit.ly/3hBhVMF Journal of the American Society of Nephrology, online July 8, 2021.

By Reuters Staff



Posted on 13 July 202120 July 2021