{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:47:33Z","timestamp":1786373253358,"version":"build-2736575974"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","funder":[{"name":"Department of Veterans Affairs Clinical Sciences Research and Development Services"},{"name":"Department of Veterans Affairs Health Services & Research Center of Innovation","award":["CX001566-01A1"],"award-info":[{"award-number":["CX001566-01A1"]}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>CKD is an independent risk factor for heart failure. Iron dysmetabolism potentially contributes to heart failure, but this relationship has not been well characterized in CKD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting, participants, &amp; measurements<\/jats:title>\n                    <jats:p>We performed a historical cohort study using data from the Veterans Affairs Corporate Data Warehouse to evaluate the relationship between iron status and heart failure hospitalization. We identified a CKD cohort with at least one set of iron indices between 2006 and 2015. The first available date of serum iron indices was identified as the study index date. The cohort was divided into four iron groups on the basis of the joint quartiles of serum transferrin saturation (shown in percent) and ferritin (shown in nanograms per milliliter): reference (16%\u201328%, 55\u2013205 ng\/ml), low iron (0.4%\u201316%, 0.9\u201355 ng\/ml), high iron (28%\u201399.5%, 205\u20134941 ng\/ml), and function iron deficiency (0.8%\u201316%, 109\u20132783 ng\/ml). We compared 1-year heart failure hospitalization risk between the iron groups using matching weights derived from multinomial propensity score models and Poisson rate-based regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 78,551 veterans met the eligibility criteria. The covariates were well balanced among the iron groups after applying the propensity score weights (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =31,819). One-year adjusted relative rate for heart failure hospitalization in the iron deficiency groups were higher compared with the reference group (low iron: 1.29 [95% confidence interval, 1.19 to 1.41]; functional iron deficiency: 1.25 [95% confidence interval, 1.13 to 1.37]). The high-iron group was associated with lower 1-year relative rate of heart failure hospitalization (0.82; 95% confidence interval, 0.72 to 0.92). Furthermore, the association between iron deficiency and heart failure hospitalization risk remained consistent regardless of the diabetes status or heart failure history at baseline.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Iron deficiency, regardless of cause, was associated with higher heart failure hospitalization risk in CKD. Higher iron status was associated with lower heart failure hospitalization risks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.15360920","type":"journal-article","created":{"date-parts":[[2021,3,29]],"date-time":"2021-03-29T15:40:17Z","timestamp":1617032417000},"page":"522-531","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":26,"title":["Heart Failure Hospitalization Risk associated with Iron Status in Veterans with CKD"],"prefix":"10.2215","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0241-4218","authenticated-orcid":false,"given":"Monique E.","family":"Cho","sequence":"first","affiliation":[{"name":"Renal Section, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah"},{"name":"Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jared L.","family":"Hansen","sequence":"additional","affiliation":[{"name":"Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah"},{"name":"Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian C.","family":"Sauer","sequence":"additional","affiliation":[{"name":"Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah"},{"name":"Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred K.","family":"Cheung","sequence":"additional","affiliation":[{"name":"Renal Section, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah"},{"name":"Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adhish","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Greene","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,3,29]]},"reference":[{"key":"B1-20241015","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1681\/ASN.2006101159","article-title":"Reduced kidney function as a risk factor for incident heart failure: The Atherosclerosis Risk in Communities (ARIC) study","volume":"18","author":"Kottgen","year":"2007","journal-title":"J Am Soc Nephrol"},{"key":"B2-20241015","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1681\/ASN.2014030253","article-title":"ESRD and death after heart failure in CKD","volume":"26","author":"Sud","year":"2015","journal-title":"J Am Soc Nephrol"},{"key":"B3-20241015","doi-asserted-by":"crossref","first-page":"57","DOI":"10.2215\/CJN.01670408","article-title":"Iron indices in chronic kidney disease in the National Health and Nutritional Examination Survey 1988-2004","volume":"4","author":"Fishbane","year":"2009","journal-title":"Clin J Am Soc Nephrol"},{"key":"B4-20241015","doi-asserted-by":"crossref","first-page":"435","DOI":"10.2215\/CJN.03980808","article-title":"Association of markers of iron stores with outcomes in patients with nondialysis-dependent chronic kidney disease","volume":"4","author":"Kovesdy","year":"2009","journal-title":"Clin J Am Soc Nephrol"},{"key":"B5-20241015","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1161\/CIRCULATIONAHA.118.030099","article-title":"Anemia and iron deficiency in heart failure: Current concepts and emerging therapies","volume":"138","author":"Anand","year":"2018","journal-title":"Circulation"},{"key":"B6-20241015","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1016\/j.jacc.2010.03.083","article-title":"Iron overload cardiomyopathy: Better understanding of an increasing disorder","volume":"56","author":"Gujja","year":"2010","journal-title":"J Am Coll Cardiol"},{"key":"B7-20241015","doi-asserted-by":"crossref","first-page":"1925","DOI":"10.1016\/j.bbadis.2018.08.030","article-title":"Role of iron metabolism in heart failure: From iron deficiency to iron overload","volume":"1865","author":"Zhang","year":"2019","journal-title":"Biochim Biophys Acta Mol Basis Dis"},{"key":"B8-20241015","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.1136\/heartjnl-2014-305669","article-title":"Iron deficiency: An emerging therapeutic target in heart failure","volume":"100","author":"Cohen-Solal","year":"2014","journal-title":"Heart"},{"key":"B9-20241015","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1016\/j.bbamcr.2012.01.014","article-title":"Hepcidin and iron homeostasis","volume":"1823","author":"Ganz","year":"2012","journal-title":"Biochim Biophys Acta"},{"key":"B10-20241015","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1093\/jn\/121.5.729","article-title":"The impact of varying degrees of iron nutriture on several functional consequences of iron deficiency in rats","volume":"121","author":"Borel","year":"1991","journal-title":"J Nutr"},{"key":"B11-20241015","first-page":"E535","article-title":"Distinguishing effects of anemia and muscle iron deficiency on exercise bioenergetics in the rat","volume":"246","author":"Davies","year":"1984","journal-title":"Am J Physiol"},{"key":"B12-20241015","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/S0140-6736(80)90019-7","article-title":"Iron deficiency and glycosylated haemoglobin A","volume":"2","author":"Brooks","year":"1980","journal-title":"Lancet"},{"key":"B13-20241015","doi-asserted-by":"crossref","first-page":"780","DOI":"10.2337\/dc09-0836","article-title":"Association between iron deficiency and A1C levels among adults without diabetes in the National Health and Nutrition Examination Survey, 1999-2006","volume":"33","author":"Kim","year":"2010","journal-title":"Diabetes Care"},{"key":"B14-20241015","first-page":"112","article-title":"Iron deficiency anemia and glucose metabolism","volume":"88","author":"Soliman","year":"2017","journal-title":"Acta Biomed"},{"key":"B15-20241015","doi-asserted-by":"crossref","first-page":"461","DOI":"10.7326\/0003-4819-130-6-199903160-00002","article-title":"A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation","volume":"130","author":"Levey","year":"1999","journal-title":"Ann Intern Med"},{"key":"B16-20241015","first-page":"1","article-title":"MICE: Multivariate imputation by chained equations in R","volume":"45","author":"van Buuren","year":"2011","journal-title":"J Stat Softw"},{"key":"B17-20241015","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/0962280217713032","article-title":"Propensity score analysis with partially observed covariates: How should multiple imputation be used?","volume":"28","author":"Leyrat","year":"2019","journal-title":"Stat Methods Med Res"},{"key":"B18-20241015","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1515\/ijb-2012-0030","article-title":"A weighting analogue to pair matching in propensity score analysis","volume":"9","author":"Li","year":"2013","journal-title":"Int J Biostat"},{"key":"B19-20241015","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1097\/EDE.0000000000000627","article-title":"Matching weights to simultaneously compare three treatment groups: Comparison to three-way matching","volume":"28","author":"Yoshida","year":"2017","journal-title":"Epidemiology"},{"key":"B20-20241015","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1080\/03610910902859574","article-title":"Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research","volume":"38","author":"Austin","year":"2009","journal-title":"Commun Stat Simul Comput"},{"key":"B21-20241015","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1186\/s12874-016-0234-z","article-title":"Adjusting for overdispersion in piecewise exponential regression models to estimate excess mortality rate in population-based research","volume":"16","author":"Luque-Fernandez","year":"2016","journal-title":"BMC Med Res Methodol"},{"key":"B22-20241015","doi-asserted-by":"crossref","first-page":"3373","DOI":"10.1002\/sim.5786","article-title":"Propensity score weighting with multilevel data","volume":"32","author":"Li","year":"2013","journal-title":"Stat Med"},{"key":"B23-20241015","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1111\/bjh.12311","article-title":"Guideline for the laboratory diagnosis of functional iron deficiency","volume":"161","author":"Thomas","year":"2013","journal-title":"Br J Haematol"},{"key":"B24-20241015","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.ahj.2013.01.017","article-title":"Iron deficiency in chronic heart failure: An international pooled analysis","volume":"165","author":"Klip","year":"2013","journal-title":"Am Heart J"},{"key":"B25-20241015","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1093\/eurjhf\/hft083","article-title":"Iron deficiency is a key determinant of health-related quality of life in patients with chronic heart failure regardless of anaemia status","volume":"15","author":"Com\u00edn-Colet","year":"2013","journal-title":"Eur J Heart Fail"},{"key":"B26-20241015","doi-asserted-by":"crossref","first-page":"1872","DOI":"10.1093\/eurheartj\/ehq158","article-title":"Iron deficiency: An ominous sign in patients with systolic chronic heart failure","volume":"31","author":"Jankowska","year":"2010","journal-title":"Eur Heart J"},{"key":"B27-20241015","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1016\/j.jacc.2006.07.015","article-title":"Intravenous iron alone for the treatment of anemia in patients with chronic heart failure","volume":"48","author":"Bolger","year":"2006","journal-title":"J Am Coll Cardiol"},{"key":"B28-20241015","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.jacc.2007.09.036","article-title":"Effect of intravenous iron sucrose on exercise tolerance in anemic and nonanemic patients with symptomatic chronic heart failure and iron deficiency FERRIC-HF: A randomized, controlled, observer-blinded trial","volume":"51","author":"Okonko","year":"2008","journal-title":"J Am Coll Cardiol"},{"key":"B29-20241015","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1016\/j.jacc.2007.07.029","article-title":"Intravenous iron reduces NT-pro-brain natriuretic peptide in anemic patients with chronic heart failure and renal insufficiency","volume":"50","author":"Toblli","year":"2007","journal-title":"J Am Coll Cardiol"},{"key":"B30-20241015","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1002\/ejhf.473","article-title":"Effects of intravenous iron therapy in iron-deficient patients with systolic heart failure: A meta-analysis of randomized controlled trials","volume":"18","author":"Jankowska","year":"2016","journal-title":"Eur J Heart Fail"},{"key":"B31-20241015","doi-asserted-by":"crossref","first-page":"2436","DOI":"10.1056\/NEJMoa0908355","article-title":"Ferric carboxymaltose in patients with heart failure and iron deficiency","volume":"361","author":"Anker","year":"2009","journal-title":"N Engl J Med"},{"key":"B32-20241015","doi-asserted-by":"crossref","first-page":"3439","DOI":"10.1016\/j.ijcard.2013.04.181","article-title":"IRON-HF study: A randomized trial to assess the effects of iron in heart failure patients with anemia","volume":"168","author":"Beck-da-Silva","year":"2013","journal-title":"Int J Cardiol"},{"key":"B33-20241015","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1093\/eurheartj\/ehu385","article-title":"Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency","volume":"36","author":"Ponikowski","year":"2015","journal-title":"Eur Heart J"},{"key":"B34-20241015","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1053\/j.ajkd.2009.10.043","article-title":"Bone marrow iron, iron indices, and the response to intravenous iron in patients with non-dialysis-dependent CKD","volume":"55","author":"Stancu","year":"2010","journal-title":"Am J Kidney Dis"}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.15360920","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:44:02Z","timestamp":1786369442000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.15360920"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,29]]},"references-count":34,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.15360920","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,29]]},"assertion":[{"value":"2020-09-23","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-02-01","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}