Cardiorenal Syndrome in Thalassemia Patients

Abstract Background Cardiorenal syndrome (CRS) is a serious condition with high morbidity and mortality. Secondary CRS (type 5 CRS) is characterized by the coexistence of cardiac abnormality and renal dysfunction occurring secondarily to a systemic condition. There is limited information about CRS in thalassemia. This study aimed to investigate the prevalence of secondary CRS in thalassemia patients and also associated risk factors.Methods In this cross-sectional cohort study, thalassemia patients who attended the out-patient clinic of University hospital from October 2016 to September 2017 were enrolled onto the study. A criterion for diagnosis of secondary CRS is based on a system proposed by Ronco and McCullough. Cardiac abnormalities are assessed by clinical presentation, establishment of acute or chronic heart failure using definitions from 2016 ESC guidelines or from structural abnormalities shown in an echocardiogram. Renal dysfunction is defined by acute kidney injury or chronic kidney disease according to 2012 KDIGO guidelines. Clinical and laboratory findings from 2 consecutive visits, three months apart, were assessed.Results Out of 90 thalassemia patients, 25 (27.8%) had secondary CRS. The multivariable analysis showed a significant correlation between CRS and extramedullary hematopoiesis (EMH) (odds ratio (OR) 20.55, p=0.016); thalassemia type [β 0 /β E vs β 0 /β 0 thalassemia (OR = 0.005, p=0.002)]; pulmonary hypertension (OR 178.1, p=0.001); elevated serum NT-proBNP (OR 1.028, p=0.022), and elevated 24-hour urine magnesium (OR 1.913, p=0.016). There was no correlation between CRS and frequency of blood transfusion, serum ferritin, liver iron concentration, cardiac T2*, type of iron chelating agents, and urine neutrophil gelatinase-associated lipocalin level.Conclusions Secondary CRS is not rare in thalassemia patients. We also identified useful condition and markers for the detection of CRS in thalassemia cases.