IV Iron Therapy Valuable Despite No Link with h-cTnT in Hemodialysis Patients: Study
A recent study published in the journal of BMC Nephrology revealed that no significant relationship between high-sensitivity cardiac troponin T (h-cTnT) and IV iron, but IV iron therapy remains important for hemodialysis patients.
The cross-sectional investigation from February 2023 to October 2024 in a dialysis unit, involved 244 patients who had been on hemodialysis for at least 3 months and were receiving IV iron therapy. All participants were aged 18 years or older. High-sensitivity cardiac troponin T levels were measured prior to dialysis, with patients grouped according to whether their h-cTnT values were at or below 60 ng/L or above that threshold.
Of the 224 patients who completed the study (137 male and 87 female, with a mean age of 59.9 years), the average IV iron dose was 255.5 mg per month. The overall mean h-cTnT was 90.5 ng/L. More than half the patients (58.5%) had h-cTnT levels exceeding 60 ng/L.
Despite initial concerns, this research found no statistically significant relationship between IV iron dose and troponin levels. However, several other factors did correlate with higher troponin values. Male patients, older individuals, and those with ischemic heart disease or cerebrovascular events showed significantly elevated h-cTnT. The patients on statins and doxazosin were more likely to fall into the high troponin group.
Clinical parameters tied to dialysis performance and nutritional status also showed noteworthy differences. The patients with h-cTnT levels above 60 ng/L had a lower processed blood volume, shorter effective dialysis time, and reduced KT/V urea values, suggesting less efficient treatment. Albumin levels were also lower in the high-troponin group, indicating potential systemic vulnerability.
These findings suggest that while IV iron therapy does not directly influence cardiac troponin T levels, other clinical and patient-related factors play a substantial role. Monitoring troponin remains critical, not for iron management alone, but for identifying patients at higher cardiovascular risk.
Overall, the results highlighted that IV iron appears to be safe in terms of its effect on troponin and is effective in managing anemia in dialysis patients. However, elevated h-cTnT still flags patients with poorer overall health, comorbidities, and less effective dialysis sessions.
Reference:
Hunjul, M., Owda, D., Sawaid, B., Saadeh, H., Enaya, A., Hamdan, Z., & Nazzal, Z. (2025). Exploring the relationship between intravenous iron therapy and troponin T levels in hemodialysis patients: a cross-sectional study. BMC Nephrology, 26(1), 510. https://doi.org/10.1186/s12882-025-04436-1
