Ferric Carboxymaltose reduces NT-proBNP and enhances functional status in chronic kidney disease and heart failure with preserved ejection fraction

Abstract

Introduction: Heart failure with preserved ejection fraction (HFpEF) accounts for approximately half of all heart failure cases and frequently coexists with chronic kidney disease (CKD), particularly in advanced stages. Iron deficiency is highly prevalent in both conditions and contributes to impaired functional capacity and adverse outcomes. Objectives: To evaluate the effect of a single intravenous ferric carboxymaltose (FCM) dose on NT-proBNP levels and NYHA class in non-dialysis CKD patients with HFpEF and iron deficiency anemia, and to assess the short-term renal safety of this intervention. Materials and Methods: In this prospective cohort study, 45 adults with stage 2–5 non-dialysis CKD, LVEF ≥50%, and NT-proBNP ≥1000 pg/mL received a single FCM infusion (500–1000 mg). We measured clinical, echocardiographic, hematologic, renal, and iron parameters at baseline and one month post-treatment. Results: NT-proBNP levels declined significantly from 3924±5841 to 2187±3652 pg/mL (p<0.001), representing a 44.3% reduction. NYHA class improved in 42% of patients (p=0.034). No significant change was observed in eGFR (33±17 to 34±16 mL/min/1.73 m², p=0.864). Iron parameters and hemoglobin levels improved significantly without infusion-related adverse events. Conclusions: Single-dose IV iron therapy in HFpEF patients with CKD was associated with significant NT-proBNP reduction and functional improvement, without evidence of short-term renal harm. These findings support IV iron as a safe and potentially beneficial intervention in this underrepresented high-risk population.