Serum ferritin is associated with arterial stiffness in hemodialysis patients: results of a 3-year follow-up study

Iron may contribute to vascular injury through reactive oxygen species. Hemodialysis patients frequently receive iron supply for correction of anemia and are at a high risk of cardiovascular disease. We tested the relationship between iron status and change in arterial stiffness in hemodialysis patients. We measured iron status in 53 hemodialysis patients and studied the association with clinical, biochemical, and arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV) over 3 years. The blood pressure was controlled to below 140/90 mmHg by anti-hypertensive drugs. Median and interquartile range of baseline baPWV, baPWV at 3 years, and Delta baPWV (difference between 3-year baPWV and baseline baPWV) were following: 17.6 (14.8-18.9), 16.9 (15.3-19.9), and 0.2 (-1.2 to 2.7) m/s. At baseline, baPWV was positively correlated with age, serum ferritin, and systolic blood pressure in univariate analysis. However, in multivariate analysis, only age and serum ferritin remained the significant determinants of baseline baPWV. After 3 years, Delta baPWV was negatively correlated with age and positively with 3-year averaged serum ferritin in univariate analysis. Then, in multivariate analysis, only 3-year averaged serum ferritin was the important determinant of Delta baPWV. Delta baPWV was significantly increased in patients with 3-year averaged serum ferritin > 500 ng/mL compared to patients with 3-year averaged serum ferritin a parts per thousand currency sign500 ng/mL. In hemodialysis patients, serum ferritin associates with the progressive arterial stiffness, especially when serum ferritin > 500 ng/mL.