IRON excess in chronic kidney disease (CKD) is independently associated with atheroma presence and progression, according to findings from the NEFRONA cohort, highlighting the potential cardiovascular implications of iron disturbances in patients with CKD. The study examined the prevalence of iron abnormalities and their relationship with vascular changes in patients with CKD without previous cardiovascular disease.
Iron Disturbances in CKD
Iron disturbances are frequent in CKD, where iron deficiency may contribute to anaemia, while iron excess may have harmful effects. Researchers assessed 1,386 participants, including 143 controls and 1,243 patients with non-dialysis CKD, to investigate associations between iron status and atheroma outcomes.
Participants were assessed for iron status at baseline, with patients with CKD undergoing vascular imaging at baseline and after 24 months. Iron excess was defined as ferritin levels of ≥500 ng/ml and transferrin saturation index (TSI)>20%. Iron deficiency was assessed using ferritin and TSI thresholds appropriate for controls and patients with CKD stages G3–G5.
Iron deficiency was more common than iron excess at baseline, occurring in 28.6% of controls and 27.7% of patients with CKD, compared with iron excess rates of 2.8% and 3.5%, respectively.
Iron Excess and Atheroma Progression
After 24 months, iron deficiency remained frequent, particularly among women, while iron excess increased from 5.1% to 7.6% and was more common in advanced CKD. Baseline iron deficiency was not associated with atheroma outcomes.
Contrastingly, iron excess was associated with both the presence and progression of atheroma plaques. Patients with iron excess had a higher prevalence of baseline atheroma plaques compared with those without excess iron (83.3% vs. 65.3%; p=0.001). Iron excess was also associated with greater atheroma progression at 24 months (79.4% vs. 58.5%; p=0.015).
After adjustment for other factors, iron excess remained independently associated with baseline atheroma and progression. Iron excess increased the likelihood of baseline atheroma (odds ratio: 3.33; 95% CI: 1.39–8.01; p=0.007) and atheroma progression (odds ratio: 2.95; 95% CI: 1.23–7.06; p=0.015).
Conclusion
The findings indicate that both persistent iron deficiency and iron excess are common among patients with CKD. However, unlike iron deficiency, iron excess was independently associated with atheromatosis. The authors highlighted that consideration should be given to avoiding iron excess in patients with CKD and atheromatosis.
Reference
Valdivielso JM et al. Iron excess is associated with atheroma presence and progression in chronic kidney disease in the NEFRONA cohort. Sci Rep. 2026;DOI: 10.1038/s41598-026-61003-w. Epub ahead of print. PMID: 42409973.
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