Additional burden of iron deficiency in heart failure patients beyond the cardio‐renal anaemia syndrome: findings from the BIOSTAT‐CHF study

Aims Whereas the combination of anaemia and chronic kidney disease (CKD) has been extensively studied in patients with heart failure (HF), the contribution of iron deficiency (ID) to this dysfunctional interplay is unknown. We aimed to assess clinical associates and pathophysiological pathways relat...

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Veröffentlicht in:European journal of heart failure 2022-01, Vol.24 (1), p.192-204
Hauptverfasser: Alnuwaysir, Ridha I.S., Grote Beverborg, Niels, Hoes, Martijn F., Markousis‐Mavrogenis, George, Gomez, Karla A., Wal, Haye H., Cleland, John G.F., Dickstein, Kenneth, Lang, Chim C., Ng, Leong L., Ponikowski, Piotr, Anker, Stefan D., Veldhuisen, Dirk J., Voors, Adriaan A., Meer, Peter
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container_issue 1
container_start_page 192
container_title European journal of heart failure
container_volume 24
creator Alnuwaysir, Ridha I.S.
Grote Beverborg, Niels
Hoes, Martijn F.
Markousis‐Mavrogenis, George
Gomez, Karla A.
Wal, Haye H.
Cleland, John G.F.
Dickstein, Kenneth
Lang, Chim C.
Ng, Leong L.
Ponikowski, Piotr
Anker, Stefan D.
Veldhuisen, Dirk J.
Voors, Adriaan A.
Meer, Peter
description Aims Whereas the combination of anaemia and chronic kidney disease (CKD) has been extensively studied in patients with heart failure (HF), the contribution of iron deficiency (ID) to this dysfunctional interplay is unknown. We aimed to assess clinical associates and pathophysiological pathways related to ID in this multimorbid syndrome. Methods and results We studied 2151 patients with HF from the BIOSTAT‐CHF cohort. Patients were stratified based on ID (transferrin saturation
doi_str_mv 10.1002/ejhf.2393
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We aimed to assess clinical associates and pathophysiological pathways related to ID in this multimorbid syndrome. Methods and results We studied 2151 patients with HF from the BIOSTAT‐CHF cohort. Patients were stratified based on ID (transferrin saturation &lt;20%), anaemia (World Health Organization definition) and/or CKD (estimated glomerular filtration rate &lt;60 ml/min/1.73 m2). Patients were mainly men (73.3%), with a median age of 70.5 (interquartile range 61.4–78.1). ID was more prevalent than CKD and anaemia (63.3%, 47.2% and 35.6% respectively), with highest prevalence in those with concomitant CKD and anaemia (77.5% vs. 59.3%; p &lt; 0.001). There was a considerable overlap in biomarkers and pathways between patients with isolated ID, anaemia or CKD, or in combination, with processes related to immunity, inflammation, cell survival and cancer amongst the common pathways. Key biomarkers shared between syndromes with ID included transferrin receptor, interleukin‐6, fibroblast growth factor‐23, and bone morphogenetic protein 6. Having ID, either alone or on top of anaemia and/or CKD, was associated with a lower overall summary Kansas City Cardiomyopathy Questionnaire score, an impaired 6‐min walk test and increased incidence of hospitalizations and/or mortality in multivariable analyses (all p &lt; 0.05). Conclusion Iron deficiency, CKD and/or anaemia in patients with HF have great overlap in biomarker profiles, suggesting common pathways associated with these syndromes. ID either alone or on top of CKD and anaemia is associated with worse quality of life, exercise capacity and prognosis of patients with worsening HF. Iron deficiency (ID) in patients with heart failure (HF) retains its adverse association with clinical outcomes regardless of concomitant anaemia and/or chronic kidney disease (CKD). In a comprehensive biomarker and pathway analysis of HF patients with ID, CKD and/or anaemia, we found an extensive overlap in biomarker profiles, suggesting similar underlying mechanisms of these syndromes despite different clinical definitions. BMP6, bone morphogenetic protein 6; CRAIDS, cardio‐renal anaemia iron deficiency syndrome; CRAS, cardio‐renal anaemia syndrome; CRIDS, cardio‐renal iron deficiency syndrome; FGF23, fibroblast growth factor 23; IDA, iron deficiency anaemia; IL‐6, interleukin‐6; TFRC, transferrin receptor. Several graphical elements were adapted from www.flaticon.com.</description><identifier>ISSN: 1388-9842</identifier><identifier>EISSN: 1879-0844</identifier><identifier>DOI: 10.1002/ejhf.2393</identifier><identifier>PMID: 34816550</identifier><language>eng</language><publisher>Oxford, UK: John Wiley &amp; Sons, Ltd</publisher><subject>Anaemia ; Anemia - complications ; Anemia - epidemiology ; Anemia, Iron-Deficiency - complications ; Anemia, Iron-Deficiency - epidemiology ; Biomarkers ; Cardio-Renal Syndrome - epidemiology ; Cardiorenal ; Chronic kidney disease ; Comorbidities ; Heart failure ; Heart Failure - complications ; Heart Failure - epidemiology ; Humans ; Iron Deficiencies ; Iron deficiency ; Male ; Quality of Life</subject><ispartof>European journal of heart failure, 2022-01, Vol.24 (1), p.192-204</ispartof><rights>2021 The Authors. published by John Wiley &amp; Sons Ltd on behalf of European Society of Cardiology.</rights><rights>2021 The Authors. European Journal of Heart Failure published by John Wiley &amp; Sons Ltd on behalf of European Society of Cardiology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4153-291685ce8bd178f155cc9021dfd501e0f79c6ec20b691c14ea9203a9c0a1eaed3</citedby><cites>FETCH-LOGICAL-c4153-291685ce8bd178f155cc9021dfd501e0f79c6ec20b691c14ea9203a9c0a1eaed3</cites><orcidid>0000-0001-8192-6670 ; 0000-0003-4629-9960 ; 0000-0002-7317-8980 ; 0000-0002-1471-7016 ; 0000-0002-0234-438X ; 0000-0002-6553-5749 ; 0000-0001-7012-9422</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fejhf.2393$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fejhf.2393$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,1416,1432,27922,27923,45572,45573,46407,46831</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34816550$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Alnuwaysir, Ridha I.S.</creatorcontrib><creatorcontrib>Grote Beverborg, Niels</creatorcontrib><creatorcontrib>Hoes, Martijn F.</creatorcontrib><creatorcontrib>Markousis‐Mavrogenis, George</creatorcontrib><creatorcontrib>Gomez, Karla A.</creatorcontrib><creatorcontrib>Wal, Haye H.</creatorcontrib><creatorcontrib>Cleland, John G.F.</creatorcontrib><creatorcontrib>Dickstein, Kenneth</creatorcontrib><creatorcontrib>Lang, Chim C.</creatorcontrib><creatorcontrib>Ng, Leong L.</creatorcontrib><creatorcontrib>Ponikowski, Piotr</creatorcontrib><creatorcontrib>Anker, Stefan D.</creatorcontrib><creatorcontrib>Veldhuisen, Dirk J.</creatorcontrib><creatorcontrib>Voors, Adriaan A.</creatorcontrib><creatorcontrib>Meer, Peter</creatorcontrib><title>Additional burden of iron deficiency in heart failure patients beyond the cardio‐renal anaemia syndrome: findings from the BIOSTAT‐CHF study</title><title>European journal of heart failure</title><addtitle>Eur J Heart Fail</addtitle><description>Aims Whereas the combination of anaemia and chronic kidney disease (CKD) has been extensively studied in patients with heart failure (HF), the contribution of iron deficiency (ID) to this dysfunctional interplay is unknown. We aimed to assess clinical associates and pathophysiological pathways related to ID in this multimorbid syndrome. Methods and results We studied 2151 patients with HF from the BIOSTAT‐CHF cohort. Patients were stratified based on ID (transferrin saturation &lt;20%), anaemia (World Health Organization definition) and/or CKD (estimated glomerular filtration rate &lt;60 ml/min/1.73 m2). Patients were mainly men (73.3%), with a median age of 70.5 (interquartile range 61.4–78.1). ID was more prevalent than CKD and anaemia (63.3%, 47.2% and 35.6% respectively), with highest prevalence in those with concomitant CKD and anaemia (77.5% vs. 59.3%; p &lt; 0.001). There was a considerable overlap in biomarkers and pathways between patients with isolated ID, anaemia or CKD, or in combination, with processes related to immunity, inflammation, cell survival and cancer amongst the common pathways. Key biomarkers shared between syndromes with ID included transferrin receptor, interleukin‐6, fibroblast growth factor‐23, and bone morphogenetic protein 6. Having ID, either alone or on top of anaemia and/or CKD, was associated with a lower overall summary Kansas City Cardiomyopathy Questionnaire score, an impaired 6‐min walk test and increased incidence of hospitalizations and/or mortality in multivariable analyses (all p &lt; 0.05). Conclusion Iron deficiency, CKD and/or anaemia in patients with HF have great overlap in biomarker profiles, suggesting common pathways associated with these syndromes. ID either alone or on top of CKD and anaemia is associated with worse quality of life, exercise capacity and prognosis of patients with worsening HF. Iron deficiency (ID) in patients with heart failure (HF) retains its adverse association with clinical outcomes regardless of concomitant anaemia and/or chronic kidney disease (CKD). In a comprehensive biomarker and pathway analysis of HF patients with ID, CKD and/or anaemia, we found an extensive overlap in biomarker profiles, suggesting similar underlying mechanisms of these syndromes despite different clinical definitions. BMP6, bone morphogenetic protein 6; CRAIDS, cardio‐renal anaemia iron deficiency syndrome; CRAS, cardio‐renal anaemia syndrome; CRIDS, cardio‐renal iron deficiency syndrome; FGF23, fibroblast growth factor 23; IDA, iron deficiency anaemia; IL‐6, interleukin‐6; TFRC, transferrin receptor. Several graphical elements were adapted from www.flaticon.com.</description><subject>Anaemia</subject><subject>Anemia - complications</subject><subject>Anemia - epidemiology</subject><subject>Anemia, Iron-Deficiency - complications</subject><subject>Anemia, Iron-Deficiency - epidemiology</subject><subject>Biomarkers</subject><subject>Cardio-Renal Syndrome - epidemiology</subject><subject>Cardiorenal</subject><subject>Chronic kidney disease</subject><subject>Comorbidities</subject><subject>Heart failure</subject><subject>Heart Failure - complications</subject><subject>Heart Failure - epidemiology</subject><subject>Humans</subject><subject>Iron Deficiencies</subject><subject>Iron deficiency</subject><subject>Male</subject><subject>Quality of Life</subject><issn>1388-9842</issn><issn>1879-0844</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kU9vFCEYh4nR2Fo9-AUMRz1MC8P8AQ8m66br1jTpwfVMGHjp0szACjOaufkR-hn7Scp2a6MHT0De531e4IfQW0pOKSHlGdxs7WnJBHuGjilvRUF4VT3Pe8Z5IXhVHqFXKd0QQtuMv0RHrOK0qWtyjG4XxrjRBa963E3RgMfBYheDxwas0w68nrHzeAsqjtgq108R8E6NuTIm3MEcvMHjFrBW0bhw9_s2wt6mvILBKZxmb2IY4CO2zhvnrxO2-fzQ8vni6ttmsck9y_UKp3Ey82v0wqo-wZvH9QR9X51vluvi8urLxXJxWeiK1qwoBW14rYF3hrbc0rrWWpCSGmtqQoHYVugGdEm6RlBNK1CiJEwJTRQFBYadoE8H727qBjA6vyaqXu6iG1ScZVBO_lvxbiuvw08pWP5HQrLg_aMghh8TpFEOLmnoe-UhTEmWDaGiFZSwjH44oDqGlCLYpzGUyH2Ccp-g3CeY2Xd_3-uJ_BNZBs4OwC_Xw_x_kzz_ul49KO8BOOmq3Q</recordid><startdate>202201</startdate><enddate>202201</enddate><creator>Alnuwaysir, Ridha I.S.</creator><creator>Grote Beverborg, Niels</creator><creator>Hoes, Martijn F.</creator><creator>Markousis‐Mavrogenis, George</creator><creator>Gomez, Karla A.</creator><creator>Wal, Haye H.</creator><creator>Cleland, John G.F.</creator><creator>Dickstein, Kenneth</creator><creator>Lang, Chim C.</creator><creator>Ng, Leong L.</creator><creator>Ponikowski, Piotr</creator><creator>Anker, Stefan D.</creator><creator>Veldhuisen, Dirk J.</creator><creator>Voors, Adriaan A.</creator><creator>Meer, Peter</creator><general>John Wiley &amp; Sons, Ltd</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-8192-6670</orcidid><orcidid>https://orcid.org/0000-0003-4629-9960</orcidid><orcidid>https://orcid.org/0000-0002-7317-8980</orcidid><orcidid>https://orcid.org/0000-0002-1471-7016</orcidid><orcidid>https://orcid.org/0000-0002-0234-438X</orcidid><orcidid>https://orcid.org/0000-0002-6553-5749</orcidid><orcidid>https://orcid.org/0000-0001-7012-9422</orcidid></search><sort><creationdate>202201</creationdate><title>Additional burden of iron deficiency in heart failure patients beyond the cardio‐renal anaemia syndrome: findings from the BIOSTAT‐CHF study</title><author>Alnuwaysir, Ridha I.S. ; Grote Beverborg, Niels ; Hoes, Martijn F. ; Markousis‐Mavrogenis, George ; Gomez, Karla A. ; Wal, Haye H. ; Cleland, John G.F. ; 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We aimed to assess clinical associates and pathophysiological pathways related to ID in this multimorbid syndrome. Methods and results We studied 2151 patients with HF from the BIOSTAT‐CHF cohort. Patients were stratified based on ID (transferrin saturation &lt;20%), anaemia (World Health Organization definition) and/or CKD (estimated glomerular filtration rate &lt;60 ml/min/1.73 m2). Patients were mainly men (73.3%), with a median age of 70.5 (interquartile range 61.4–78.1). ID was more prevalent than CKD and anaemia (63.3%, 47.2% and 35.6% respectively), with highest prevalence in those with concomitant CKD and anaemia (77.5% vs. 59.3%; p &lt; 0.001). There was a considerable overlap in biomarkers and pathways between patients with isolated ID, anaemia or CKD, or in combination, with processes related to immunity, inflammation, cell survival and cancer amongst the common pathways. Key biomarkers shared between syndromes with ID included transferrin receptor, interleukin‐6, fibroblast growth factor‐23, and bone morphogenetic protein 6. Having ID, either alone or on top of anaemia and/or CKD, was associated with a lower overall summary Kansas City Cardiomyopathy Questionnaire score, an impaired 6‐min walk test and increased incidence of hospitalizations and/or mortality in multivariable analyses (all p &lt; 0.05). Conclusion Iron deficiency, CKD and/or anaemia in patients with HF have great overlap in biomarker profiles, suggesting common pathways associated with these syndromes. ID either alone or on top of CKD and anaemia is associated with worse quality of life, exercise capacity and prognosis of patients with worsening HF. Iron deficiency (ID) in patients with heart failure (HF) retains its adverse association with clinical outcomes regardless of concomitant anaemia and/or chronic kidney disease (CKD). In a comprehensive biomarker and pathway analysis of HF patients with ID, CKD and/or anaemia, we found an extensive overlap in biomarker profiles, suggesting similar underlying mechanisms of these syndromes despite different clinical definitions. BMP6, bone morphogenetic protein 6; CRAIDS, cardio‐renal anaemia iron deficiency syndrome; CRAS, cardio‐renal anaemia syndrome; CRIDS, cardio‐renal iron deficiency syndrome; FGF23, fibroblast growth factor 23; IDA, iron deficiency anaemia; IL‐6, interleukin‐6; TFRC, transferrin receptor. 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subjects Anaemia
Anemia - complications
Anemia - epidemiology
Anemia, Iron-Deficiency - complications
Anemia, Iron-Deficiency - epidemiology
Biomarkers
Cardio-Renal Syndrome - epidemiology
Cardiorenal
Chronic kidney disease
Comorbidities
Heart failure
Heart Failure - complications
Heart Failure - epidemiology
Humans
Iron Deficiencies
Iron deficiency
Male
Quality of Life
title Additional burden of iron deficiency in heart failure patients beyond the cardio‐renal anaemia syndrome: findings from the BIOSTAT‐CHF study
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