Abstract 14472: Iron Deficiency Plays an Important Prognostic Role in the Cardiorenal Anemia Axis: A Pooled Multicenter Analysis
Background: Anemia, chronic kidney disease (CKD) and iron deficiency (ID) are frequently observed comorbidities in chronic heart failure (HF) and all independent predictors of outcome. The combination of anemia and renal dysfunction in chronic HF has been described as the cardiorenal anemia syndrome. However, the role of ID within this complex interplay of adverse phenomena is unknown.
Methods: In an international pooled cohort comprising 1,506 patients with chronic HF, we aimed to study the clinical correlates of ID (defined as a ferritin level < 100 ug/L or 100-299 ug/L in combination with a transferrin saturation < 20%), anemia, CKD (defined as an eGFR < 60 ml/min/1.73m2), or a combination of these comorbidities and their underlying prognostic consequences.
Results: Mean age was 64 ± 13 years, 74% was male and 85% had NYHA class II or III. The presence of either ID, anemia, CKD or combination of these comorbidities was observed in 69% of the patients. During a median follow-up of 1.92 years (interquartile range 1.18 -3.26 years), 440 patients (29%) died. Per increasing number of comorbidities 8-year mortality rates increased significantly from 19% to 26%, 40% and 55%, respectively (p < 0.001). Multivariate hazard models revealed ID to be the key determinant of prognosis, either individually (p = 0.042) or in combination with either anemia (p = 0.006), CKD (p = 0.029) or both (p = 0.017).
Conclusions: In conclusion, the prevalence of ID, anemia, CKD or combination of comorbidities is common in patients with chronic HF and is associated with an impaired survival per increasing number of comorbidities. In this study, ID is a strong independent predictor of outcome, either as a sole predictor or in combination with anemia, CKD or both.
- © 2013 by American Heart Association, Inc.