Skip to main content
SpringerLink
Log in

Serum ferritin is an independent factor in coronary artery stenosis among hemodialysis patients

  • Original Article
  • Published:
International Journal of Hematology Aims and scope Submit manuscript

Abstract

Hemodialysis patients frequently receive intravenous iron for the treatment of anemia. Iron status has been found to be correlated with coronary artery disease. In the post hoc study reported here, we evaluate the association between iron status and coronary arterial stenosis (CAS) in a 3-year follow-up period. We enrolled 76 patients and collected iron status, and clinical/biochemical data over 3 years. In this study, coronary arterial stenosis was considered significant when the narrowing of the coronary artery exceeded 50 % of the luminal diameter on coronary angiography. The mean age was 61 years old. The female/male ratio was 48/28, and the group included 16 diabetic patients and 23 smokers. Twenty-two of 76 patients had CAS. Mean intravenous iron dosage was 2167.11 ± 1738.38 in a 3-year period. On the univariate regression analysis, 3-year-averaged serum ferritin was positively associated with CAS (r = 0.288, P = 0.012). The 3-year-averaged intravenous iron dosage, DM, age, smoking, and other biochemical parameters showed no association with CAS. When these factors were added to the multivariate-adjusted models, 3-year-averaged serum ferritin remained a determinant of CAS event (β = 0.290, P = 0.029). The odds ratio for CAS was 6.93 (95 % CI 2.41–19.94; P = 0.001) for patients with 3-year-averaged serum ferritin ≥600 ng/mL. In summary, serum ferritin was an independent risk factor for CAS among this group of hemodialysis patients, especially when serum ferritin was ≥600 ng/mL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Foley RN, Parfrey PS, Sarnak MJ. Epidemiology of cardiovascular disease in chronic renal disease. J Am Soc Nephrol. 1998;9(12 Suppl):S16–23.

    CAS  PubMed  Google Scholar 

  2. Kannel WB, Dawber TR, Kagan A, Revotskie N, Stokes J 3rd. Factors of risk in the development of coronary heart disease—six year follow-up experience. The Framingham Study. Ann Intern Med. 1961;55:33–50.

    Article  CAS  PubMed  Google Scholar 

  3. Stampfer MJ, Malinow MR, Willett WC, Newcomer LM, Upson B, Ullmann D, et al. A prospective study of plasma homocyst(e)ine and risk of myocardial infarction in US physicians. JAMA. 1992;268:877–81.

    Article  CAS  PubMed  Google Scholar 

  4. Rosengren A, Wilhelmsen L, Eriksson E, Risberg B, Wedel H. Lipoprotein (a) and coronary heart disease: a prospective case–control study in a general population sample of middle aged men. BMJ. 1990;301:1248–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Parfrey PS, Foley RN, Harnett JD, Kent GM, Murray DC, Barre PE. Outcome and risk factors for left ventricular disorders in chronic uraemia. Nephrol Dial Transplant. 1996;11:1277–85.

    Article  CAS  PubMed  Google Scholar 

  6. Muntner P, He J, Astor BC, Folsom AR, Coresh J. Traditional and nontraditional risk factors predict coronary heart disease in chronic kidney disease: results from the atherosclerosis risk in communities study. J Am Soc Nephrol. 2005;16:529–38.

    Article  PubMed  Google Scholar 

  7. Himmelfarb J, Stenvinkel P, Ikizler TA, Hakim RM. The elephant in uremia: oxidant stress as a unifying concept of cardiovascular disease in uremia. Kidney Int. 2002;62:1524–38.

    Article  CAS  PubMed  Google Scholar 

  8. Ramakrishna G, Rooke TW, Cooper LT. Iron and peripheral arterial disease: revisiting the iron hypothesis in a different light. Vasc Med. 2003;8:203–10.

    Article  PubMed  Google Scholar 

  9. Vinchi F, Muckenthaler MU, Da Silva MC, Balla G, Balla J, Jeney V. Atherogenesis and iron: from epidemiology to cellular level. Front Pharmacol. 2014;5:94.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Sullivan JL. Iron and the sex difference in heart disease risk. Lancet. 1981;1:1293–4.

    Article  CAS  PubMed  Google Scholar 

  11. Drueke T, Witko-Sarsat V, Massy Z, Descamps-Latscha B, Guerin AP, Marchais SJ, et al. Iron therapy, advanced oxidation protein products, and carotid artery intima-media thickness in end-stage renal disease. Circulation. 2002;106:2212–7.

    Article  PubMed  Google Scholar 

  12. Lien CT, Lin KC, Tsai YF, Yu LK, Huang LH, Chen CA. Serum ferritin is associated with progression of peripheral arterial disease in hemodialysis patients. Clin Exp Nephrol. 2015;19:947–52.

    Article  CAS  PubMed  Google Scholar 

  13. Lin KC, Tsai MY, Chi CL, Yu LK, Huang LH, Chen CA. Serum ferritin is associated with arterial stiffness in hemodialysis patients: results of a 3-year follow-up study. Int Urol Nephrol. 2015;47:1847–53.

    Article  CAS  PubMed  Google Scholar 

  14. Le Feuvre C, Dambrin G, Helft G, Beygui F, Touam M, Grunfeld JP, et al. Clinical outcome following coronary angioplasty in dialysis patients: a case–control study in the era of coronary stenting. Heart. 2001;85:556–60.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Yasuda K, Kasuga H, Aoyama T, Takahashi H, Toriyama T, Kawade Y, et al. Comparison of percutaneous coronary intervention with medication in the treatment of coronary artery disease in hemodialysis patients. J Am Soc Nephrol. 2006;17:2322–32.

    Article  PubMed  Google Scholar 

  16. Senol E, Ersoy A, Erdinc S, Sarandol E, Yurtkuran M. Oxidative stress and ferritin levels in haemodialysis patients. Nephrol Dial Transplant. 2008;23:665–72.

    Article  CAS  PubMed  Google Scholar 

  17. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease. Am J Kidney Dis. 2006;47:S11–145.

  18. Ohtake T, Kobayashi S, Moriya H, Negishi K, Okamoto K, Maesato K, et al. High prevalence of occult coronary artery stenosis in patients with chronic kidney disease at the initiation of renal replacement therapy: an angiographic examination. J Am Soc Nephrol. 2005;16:1141–8.

    Article  PubMed  Google Scholar 

  19. Bal Z, Bal U, Okyay K, Yilmaz M, Balcioglu S, Turgay O, et al. Hematological parameters can predict the extent of coronary artery disease in patients with end-stage renal disease. Int Urol Nephrol. 2015;47:1719–25.

    Article  CAS  PubMed  Google Scholar 

  20. Kalantar-Zadeh K, Ikizler TA, Block G, Avram MM, Kopple JD. Malnutrition–inflammation complex syndrome in dialysis patients: causes and consequences. Am J Kidney Dis. 2003;42:864–81.

    Article  PubMed  Google Scholar 

  21. Salonen JT, Nyyssonen K, Korpela H, Tuomilehto J, Seppanen R, Salonen R. High stored iron levels are associated with excess risk of myocardial infarction in eastern Finnish men. Circulation. 1992;86(3):803–11.

    Article  CAS  PubMed  Google Scholar 

  22. Haidari M, Javadi E, Sanati A, Hajilooi M, Ghanbili J. Association of increased ferritin with premature coronary stenosis in men. Clin Chem. 2001;47:1666–72.

    CAS  PubMed  Google Scholar 

  23. Klipstein-Grobusch K, Koster JF, Grobbee DE, Lindemans J, Boeing H, Hofman A, et al. Serum ferritin and risk of myocardial infarction in the elderly: the Rotterdam Study. Am J Clin Nutr. 1999;69:1231–6.

    CAS  PubMed  Google Scholar 

  24. van der A DL, Marx JJ, Grobbee DE, Kamphuis MH, Georgiou NA, van Kats-Renaud JH, et al. Non-transferrin-bound iron and risk of coronary heart disease in postmenopausal women. Circulation. 2006;113:1942–9.

    Article  Google Scholar 

  25. Sun Q, Ma J, Rifai N, Franco OH, Rexrode KM, Hu FB. Excessive body iron stores are not associated with risk of coronary heart disease in women. J Nutr. 2008;138:2436–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Knuiman MW, Divitini ML, Olynyk JK, Cullen DJ, Bartholomew HC. Serum ferritin and cardiovascular disease: a 17-year follow-up study in Busselton, Western Australia. Am J Epidemiol. 2003;158:144–9.

    Article  CAS  PubMed  Google Scholar 

  27. Sempos CT, Looker AC, Gillum RE, McGee DL, Vuong CV, Johnson CL. Serum ferritin and death from all causes and cardiovascular disease: the NHANES II Mortality Study. National Health and Nutrition Examination Study. Ann Epidemiol. 2000;10:441–8.

    Article  CAS  PubMed  Google Scholar 

  28. Sung KC, Kang SM, Cho EJ, Park JB, Wild SH, Byrne CD. Ferritin is independently associated with the presence of coronary artery calcium in 12,033 men. Arterioscler Thromb Vasc Biol. 2012;32:2525–30.

    Article  CAS  PubMed  Google Scholar 

  29. Day SM, Duquaine D, Mundada LV, Menon RG, Khan BV, Rajagopalan S, et al. Chronic iron administration increases vascular oxidative stress and accelerates arterial thrombosis. Circulation. 2003;107:2601–6.

    CAS  PubMed  Google Scholar 

  30. Zhang WJ, Wei H, Frei B. The iron chelator, desferrioxamine, reduces inflammation and atherosclerotic lesion development in experimental mice. Exp Biol Med (Maywood). 2010;235:633–41.

    Article  CAS  Google Scholar 

  31. Rocha LA, Barreto DV, Barreto FC, Dias CB, Moyses R, Silva MR, et al. Serum ferritin level remains a reliable marker of bone marrow iron stores evaluated by histomorphometry in hemodialysis patients. Clin J Am Soc Nephrol. 2009;4:105–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Kletzmayr J, Horl WH. Iron overload and cardiovascular complications in dialysis patients. Nephrol Dial Transplant. 2002;17(Suppl 2):25–9.

    Article  CAS  PubMed  Google Scholar 

  33. Ellervik C, Marott JL, Tybjaerg-Hansen A, Schnohr P, Nordestgaard BG. Total and cause-specific mortality by moderately and markedly increased ferritin concentrations: general population study and metaanalysis. Clin Chem. 2014;60:1419–28.

    Article  CAS  PubMed  Google Scholar 

  34. Jacobs A, Miller F, Worwood M, Beamish MR, Wardrop CA. Ferritin in the serum of normal subjects and patients with iron deficiency and iron overload. Br Med J. 1972;4:206–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Kalantar-Zadeh K, Lee GH. The fascinating but deceptive ferritin: to measure it or not to measure it in chronic kidney disease? Clin J Am Soc Nephrol. 2006;1(Suppl):S9–18.

    Article  CAS  PubMed  Google Scholar 

  36. Rambod M, Kovesdy CP, Kalantar-Zadeh K. Combined high serum ferritin and low iron saturation in hemodialysis patients: the role of inflammation. Clin J Am Soc Nephrol. 2008;3:1691–701.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Kalantar-Zadeh K, Rodriguez RA, Humphreys MH. Association between serum ferritin and measures of inflammation, nutrition and iron in haemodialysis patients. Nephrol Dial Transplant. 2004;19(1):141–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Department of Diagnostic Radiology, Tainan Sinlau Hospital, Tainan, Taiwan

      Chen-Tung Lien

    2. Department of Surgery, Tainan Sinlau Hospital, Tainan, Taiwan

      Chiang-Chin Tsai

    3. Department of Health Care Administration, Chang Jung Christian University, Tainan, Taiwan

      Chiang-Chin Tsai

    4. Department of Nephrology, Tainan Sinlau Hospital, No. 57, 1 Sec., Dongmen Rd., Tainan, Taiwan

      Chien-An Chen

    5. Department of Cardiology, Tainan Sinlau Hospital, Tainan, Taiwan

      Chieh Kuo

    6. Department of Hematology, Tainan Sinlau Hospital, Tainan, Taiwan

      Meng-Yi Tsai

    Authors
    1. Chen-Tung Lien
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Chiang-Chin Tsai
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Chien-An Chen
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Chieh Kuo
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Meng-Yi Tsai
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Chien-An Chen.

    Ethics declarations

    Conflict of interest

    All authors declare no conflict of interest.

    Ethical approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

    Additional information

    C.-T. Lien and C.-C. Tsai contributed equally to this work.

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Lien, CT., Tsai, CC., Chen, CA. et al. Serum ferritin is an independent factor in coronary artery stenosis among hemodialysis patients. Int J Hematol 104, 440–445 (2016). https://doi.org/10.1007/s12185-016-2045-8

    Download citation

    • Received:

    • Revised:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s12185-016-2045-8

    Keywords

    Search

    Navigation