Eur J Heart Fail. 2026 May 15:xuag171. doi: 10.1093/ejhf/xuag171. Online ahead of print.
ABSTRACT
BACKGROUND AND AIMS: Iron deficiency occurs commonly in chronic kidney disease (CKD), but its association with heart failure and other cardiovascular outcomes, independent of anemia, is not well defined.
METHODS: We conducted a post-hoc analysis of the Anaemia Studies in CKD: Erythropoiesis via a Novel prolyl hydroxylase inhibitor Daprodustat-Non-Dialysis (ASCEND-ND) trial. We assessed the independent associations of transferrin saturation (TSAT) and ferritin levels with cardiovascular and mortality outcomes using time-updated multivariable Cox regression models. The primary outcome was heart failure hospitalization (HFH) or cardiovascular death.
RESULTS: Among 3,872 participants (median age 67 years, 56% women, median estimated glomerular filtration rate 18 mL/min/1.73m2), those with lower TSAT were more likely to be women, have diabetes, atrial fibrillation, and a history of cardiovascular disease. In fully adjusted models (including hemoglobin), compared to TSAT >30-≤40%, time-updated TSAT ≤20% was associated with a 2-fold higher risk of the primary outcome (HR 2.13, 95% CI 1.62-2.80), with similar associations observed for HFH (HR 1.97, 95% CI 1.40-2.79) and for cardiovascular death (HR 2.19, 95% CI 1.45-3.29), as well as all-cause mortality (HR 1.60, 95% CI 1.25-2.03). Ferritin levels ≤100 ng/mL (vs >100 to ≤300 ng/mL) were not associated with a higher risk of any cardiovascular or mortality outcomes.
CONCLUSIONS: Iron deficiency defined by low transferrin saturation, but not low ferritin levels, is associated with increased risk of heart failure and cardiovascular death in CKD, independent of hemoglobin.
PMID:42139543 | DOI:10.1093/ejhf/xuag171