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Poor efficacy of oral iron replacement therapy in pediatric patients with heart failure

Published online by Cambridge University Press:  11 October 2021

Kriti Puri Open the ORCID record for Kriti Puri [Opens in a new window] ,
Joseph A. Spinner ,
Jacquelyn M. Powers ,
Susan W. Denfield ,
Hari P. Tunuguntla ,
Swati Choudhry ,
William J. Dreyer  and
Jack F. Price
Kriti Puri
Affiliation:
Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
Joseph A. Spinner
Affiliation:
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
Jacquelyn M. Powers
Affiliation:
Section of Hematology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
Susan W. Denfield
Affiliation:
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
Hari P. Tunuguntla
Affiliation:
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
Swati Choudhry
Affiliation:
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
William J. Dreyer
Affiliation:
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
Jack F. Price*
Affiliation:
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
*
Author for correspondence: Jack F. Price, MD, Professor of Pediatrics, Lille Frank Abercrombie Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, 6651 Main Street, Legacy Tower MC E1920, Houston, TX77030, USA. Tel: 832-826-5048; Fax: 832-825-5899. E-mail: jfprice@texaschildrens.org
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Abstract

Introduction:

Iron deficiency is associated with worse outcomes in children and adults with systolic heart failure. While oral iron replacement has been shown to be ineffective in adults with heart failure, its efficacy in children with heart failure is unknown. We hypothesised that oral iron would be ineffective in replenishing iron stores in ≥50% of children with heart failure.

Methods:

We performed a single-centre retrospective cohort study of patients aged ≤21 years with systolic heart failure and iron deficiency who received oral iron between 01/2013 and 04/2019. Iron deficiency was defined as ≥2 of the following: serum iron <50 mcg/dL, serum ferritin <20 ng/mL, transferrin >300 ng/mL, transferrin saturation <15%. Iron studies and haematologic indices pre- and post-iron therapy were compared using paired-samples Wilcoxon test.

Results:

Fifty-one children with systolic heart failure and iron deficiency (median age 11 years, 49% female) met inclusion criteria. Heart failure aetiologies included cardiomyopathy (51%), congenital heart disease (37%), and history of heart transplantation with graft dysfunction (12%). Median dose of oral iron therapy was 2.9 mg/kg/day of elemental iron, prescribed for a median duration of 96 days. Follow-up iron testing was available for 20 patients, of whom 55% (11/20) remained iron deficient despite oral iron therapy.

Conclusions:

This is the first report on the efficacy of oral iron therapy in children with heart failure. Over half of the children with heart failure did not respond to oral iron and remained iron deficient.

Keywords

Paediatric heart failureiron deficiencyiron replacement therapy
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 8 , August 2022 , pp. 1302 - 1309
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Presentations: Poster presentation at the annual meeting of the International Society of Heart and Lung Transplantation in April 2020 (virtual due to COVID-19).

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