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

Factors affecting arteriovenous access patency after percutaneous transluminal angioplasty in chronic haemodialysis patients under vascular access monitoring and surveillance: a single-centre observational study

OBJECTIVES

Maintenance of vascular access (VA) patency after percutaneous transluminal angioplasty (PTA) is important and remains a challenge despite VA monitoring and surveillance. The aim of this study was to examine factors affecting the post-PTA arteriovenous access (AVA) patency in patients who have been on close VA monitoring and surveillance for access flow.

DESIGN

Retrospective cohort study.

SETTING

A single medical centre in Taiwan.

PARTICIPANTS

Records of patients who received chronic haemodialysis between 1 January 2017 and 31 December 2018 were retrospectively reviewed. Patients were divided into two groups (without or with PTA intervention on AVA).

PRIMARY AND SECONDARY OUTCOME

Patients were followed until reintervention PTA, termination or abandoned VA or end of study. In addition to routine monitoring, VA flow surveillance was performed every 3 months for detection of VA dysfunction adhering to Kidney Disease Outcomes Quality Initiative guidelines.

RESULTS

A total of 508 patients were selected for study inclusion (with PTA, n=231; without PTA, n=277). At baseline, variables that differed between groups included malignancy and levels of albumin, uric acid, potassium, phosphorous, high-density lipoprotein, total bilirubin and ferritin (all p<0.05). Significant between-group differences were observed for β-adrenergic blocking agents (with PTA, 49.8%; without PTA, 37.5%; p, 0.007) and ADP inhibitors (with PTA, 23.8%; without PTA, 11.2%; p<0.001). Among patients with PTA, those with acute myocardial infarction, high ferritin level or arteriovenous graft (AVG) had a significantly higher risk of reintervention post-PTA (p<0.05). Dipeptidyl peptidase-4 inhibitors, thiazolidinediones, ADP inhibitors, and warfarin use were predictors of post-PTA patency (p<0.05).

CONCLUSIONS

AVG access type, acute myocardial infarction, and high ferritin levels are risk factors for re-intervention post-PTA. These findings may be useful in the development of prophylactic strategies for monitoring VA function and tailoring surveillance programs for these dialysis patients.

Long-Term Prognosis of Hyperferritinemia Induced by Intravenous Iron Therapy in Patients Undergoing Maintenance Hemodialysis: A 10-Year, Single-Center Study

Optimal ferritin level in hemodialysis patients between Japan and other countries is controversial. Long-term side effects of iron supplementation in these patients remain unclear. We aimed to elucidate whether past hyperferritinemia in hemodialysis patients was associated with high risk of death and cerebrovascular and cardiovascular diseases (CCVDs). This small retrospective cohort study included approximately 44 patients unintentionally supplemented with excessive intravenous iron. A significantly higher risk of CCVDs was observed in patients with initial serum ferritin levels ≥1000 ng/mL than in the remaining patients. High ferritin levels slowly decreased to <300 ng/mL in a median of 24.2 (10.5–46.5) months without treatment. However, compared with the remaining patients, only patients whose ferritin levels did not decrease to <300 ng/mL steadily had a significantly higher risk of all-cause death (hazard ratio, 9.6). Long-term hyperferritinemia due to intravenous iron therapy is a risk factor for death in maintenance hemodialysis patients. For a prolonged better prognosis, intravenous iron should be carefully administered so as to avoid hyperferritinemia in patients with hemodialysis.

Dietary intake as a predictor for all-cause mortality in hemodialysis subjects (NUGE-HD study)

This study aimed to identify the factors capable of mortality prediction in patients on hemodialysis, using a prospective cohort with three years of follow-up. We hypothesized that lack of clinical-metabolic control, impairment of nutritional status, and inadequate food consumption are risk factors for mortality in this population. This is a longitudinal study on a non-probabilistic sample of 85 adults and elderly patients undergoing hemodialysis, aged ≥ 18 years (66.0% male, 61.6±13.7 years). Data on anthropometric, biomarkers, body composition and food intake were obtained. Predictors of mortality were evaluated using Cox regression analysis. During the three years follow-up, 16 patients (18.8%) died. We observed that age (HR = 1.319, CI 95% = 1.131–1.538), calcium-phosphorus product (HR = 1.114, CI 95% = 1.031–1.205), ferritin (HR = 1.001, CI 95% = 1.001–1.002), nitric oxide (HR = 1.082, CI 95% = 1.006–1.164), and vitamin C intake (HR = 1.005, CI 95% = 1.001–1.009) were positively associated with mortality. Serum iron (HR = 0.717, CI 95% = 0.567–0.907), triceps skinfold thickness (HR = 0.704, CI 95% = 0.519–0.954), lean mass (HR = 0.863, CI 95% = 0.787–0.945), and the ratio of dietary monounsaturated/polyunsaturated fat (HR = 0.022, CI 95% = 0.001–0.549) were independent negative predictors of mortality. Our results suggest that dietary intake is also a predictor of mortality in patients on hemodialysis, besides nutritional status, body composition, oxidative stress, inflammation, and bone metabolism, indicating the importance of evaluation of these factors altogether for better prognosis.

Impaired renal function and abnormal level of ferritin are independent risk factors of left ventricular aneurysm after acute myocardial infarction: A hospital-based case-control study

This study was performed to determine the prognostic value of glomerular filtration rate (GFR) and ferritin compromised in left ventricular aneurysm (LVA) patients who suffered acute myocardial infarction (AMI) beforehand.A hospital-based case-control study was conducted in the Department of Cardiology, First Affiliated Hospital, Zhejiang University in 2013 and 2014. Patients were divided into 3 groups according to kidney function and ferritin level. Observation outcomes include age, sex, C-reaction protein (CRP), medical history including major risk factors for CAD, ferritin and GFR, previous angina, time between MI and coronary angiography or time to rescue (TTR), and prior treatment.Around 60 patients were included in the case group (AMI with LVA) and 133 matched patients (AMI without LVA) in the control group. The prevalence of single-vessel disease (odd ratio [OR] = 2.490; 95% confidential interval [95% CI] = 1.376-4.506; P = .002), total LAD occlusion (OR = 1.897; 95% CI = 1.024-3.515; P = .041), absence of previous angina (OR = 1.930; 95% CI = 1.035-3.600; P = .037), time between myocardial infraction (MI) and coronary angiography more than 12 h (OR = 1.970; 95% CI = 1.044-3.719; P = .035), GFR less than 60 mL/min (OR = 2.933; 95% CI = 1.564-5.503; P = .001), and ferritin levels (P = .0003) were all higher in the aneurysm group compared with those in the control group. After adjustments for other variables, single-vessel disease (OR = 1.211; 95% CI = 1.080-1.342; P = .02), GFR lower than 60 mL/min (OR = 1.651; 95% CI = 1.250-2.172; P = .013), and high or low levels of ferritin (OR = 1.151; 95% CI = 1.050-1.252; P = .042) remained the independent determinants of LVA formation after AMI.Decreased GFR and abnormal ferritin levels are independent risk factors of LVA formation after AMI.