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<p>Iron disturbances are frequent in chronic kidney disease (CKD), where deficiency may contribute to anemia and excess may have harmful effects. We examined the prevalence of iron disturbances and their association with atheroma progression in the NEFRONA cohort. A total of 1386 participants (143 controls, 1243 with non-dialysis CKD) without prior cardiovascular disease were included. Controls were assessed at baseline, and CKD patients underwent vascular imaging at baseline and after 24 months. Iron excess was defined as ferritin ≥500 ng/ml and transferrin saturation index (TSI)&gt;20%. Absolute iron deficiency was defined in controls as ferritin levels &lt;30 ng/ml; and in CKD G3-G5 as ferritin ≤100 ng/ml and TSI ≤20% while functional iron deficiency was defined as ferritin ≥100 ng/ml and TSI≤20%. Iron deficiency was more common than excess at baseline (28.6% in controls, 27.7% in CKD vs. 2.8% and 3.5%, respectively). At 24 months, iron deficiency remained frequent, especially in women, while iron excess increased from 5.1% to 7.6%, being more common in advanced CKD. Baseline iron deficiency was not related to atheroma outcomes. In contrast, iron excess was associated with a higher prevalence of baseline atheroma plaques (83.3% vs. 65.3%, p=0.001) and progression at 24 months (79.4% vs. 58.5%, p=0.015). In fully adjusted logistic regression, iron excess increased the risk of baseline atheroma (OR 3.33, 95% CI 1.39–8.01, p=0.007) and progression (OR 2.95, 95% CI 1.23–7.06, p=0.015). In conclusion, both persistent iron deficiency and excess are common in CKD and iron excess is independently associated with atheromatosis.</p>

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Iron excess is associated with atheroma presence and progression in chronic kidney disease in the NEFRONA cohort

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  • 发表日期：

    2026年7月6日

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  • Jose M. Valdivielso,
  • Juan M. Diaz-Tocados,
  • Manuel Marti-Antonio,
  • Beatriz Fernandez-Fernandez,
  • Serafí Cambray,
  • Marcelino Bermúdez-López,
  • Alberto Ortiz

摘要

Iron disturbances are frequent in chronic kidney disease (CKD), where deficiency may contribute to anemia and excess may have harmful effects. We examined the prevalence of iron disturbances and their association with atheroma progression in the NEFRONA cohort. A total of 1386 participants (143 controls, 1243 with non-dialysis CKD) without prior cardiovascular disease were included. Controls were assessed at baseline, and CKD patients underwent vascular imaging at baseline and after 24 months. Iron excess was defined as ferritin ≥500 ng/ml and transferrin saturation index (TSI)>20%. Absolute iron deficiency was defined in controls as ferritin levels <30 ng/ml; and in CKD G3-G5 as ferritin ≤100 ng/ml and TSI ≤20% while functional iron deficiency was defined as ferritin ≥100 ng/ml and TSI≤20%. Iron deficiency was more common than excess at baseline (28.6% in controls, 27.7% in CKD vs. 2.8% and 3.5%, respectively). At 24 months, iron deficiency remained frequent, especially in women, while iron excess increased from 5.1% to 7.6%, being more common in advanced CKD. Baseline iron deficiency was not related to atheroma outcomes. In contrast, iron excess was associated with a higher prevalence of baseline atheroma plaques (83.3% vs. 65.3%, p=0.001) and progression at 24 months (79.4% vs. 58.5%, p=0.015). In fully adjusted logistic regression, iron excess increased the risk of baseline atheroma (OR 3.33, 95% CI 1.39–8.01, p=0.007) and progression (OR 2.95, 95% CI 1.23–7.06, p=0.015). In conclusion, both persistent iron deficiency and excess are common in CKD and iron excess is independently associated with atheromatosis.