BACKGROUND AND OBJECTIVES: Iron (Fe) overload may complicate parenteral Fe therapy used to enhance the efficacy of erythropoietic-stimulating agents in the treatment of anemia of chronic kidney disease. However, serum Fe markers are influenced by inflammation or malignancy and may not accurately reflect the amount of body Fe. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We studied the relationship between parenteral Fe therapy, conventional serum Fe markers, and liver iron concentration (LIC) measured using magnetic resonance R2 relaxometry (FerriScan) in 25 Fe-deficient predialysis chronic kidney disease patients before and 2 and 12 weeks after single high-dose intravenous Fe and in 15 chronic hemodialysis patients with elevated serum ferritin (>500 μg/L). RESULTS: In predialysis patients, there was strong dose dependency between the administered Fe dose and changes in LIC at weeks 2 and 12; however, no dose dependency between Fe dose and changes in ferritin or transferrin saturation (TSAT) were observed. In hemodialysis patients, LIC correlated with the cumulative Fe dose and duration of dialysis but not with current ferritin or TSAT. The cumulative Fe dose remained a significant independent predictor of LIC in a multiple regression model. Two dialysis patients who received >6 g parenteral Fe had substantially elevated LIC >130 μmol/g, which is associated with hemochromatosis. CONCLUSIONS: In Fe-deficient predialysis patients, intravenous Fe therapy is associated with increases in LIC unrelated to changes in conventional Fe markers. In hemodialysis patients, TSAT and ferritin are poor indicators of body Fe load, and some patients have LICs similar to those found in hemochromatosis.
BACKGROUND AND OBJECTIVES:Iron (Fe) overload may complicate parenteral Fe therapy used to enhance the efficacy of erythropoietic-stimulating agents in the treatment of anemia of chronic kidney disease. However, serum Fe markers are influenced by inflammation or malignancy and may not accurately reflect the amount of body Fe. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We studied the relationship between parenteral Fe therapy, conventional serum Fe markers, and liver iron concentration (LIC) measured using magnetic resonance R2 relaxometry (FerriScan) in 25 Fe-deficient predialysis chronic kidney diseasepatients before and 2 and 12 weeks after single high-dose intravenous Fe and in 15 chronic hemodialysis patients with elevated serum ferritin (>500 μg/L). RESULTS: In predialysis patients, there was strong dose dependency between the administered Fe dose and changes in LIC at weeks 2 and 12; however, no dose dependency between Fe dose and changes in ferritin or transferrin saturation (TSAT) were observed. In hemodialysis patients, LIC correlated with the cumulative Fe dose and duration of dialysis but not with current ferritin or TSAT. The cumulative Fe dose remained a significant independent predictor of LIC in a multiple regression model. Two dialysis patients who received >6 g parenteral Fe had substantially elevated LIC >130 μmol/g, which is associated with hemochromatosis. CONCLUSIONS: In Fe-deficient predialysis patients, intravenous Fe therapy is associated with increases in LIC unrelated to changes in conventional Fe markers. In hemodialysis patients, TSAT and ferritin are poor indicators of body Fe load, and some patients have LICs similar to those found in hemochromatosis.
Authors: G E Cartwright; C Q Edwards; K Kravitz; M Skolnick; D B Amos; A Johnson; L Buskjaer Journal: N Engl J Med Date: 1979-07-26 Impact factor: 91.245
Authors: Alexander Neuwelt; Navneet Sidhu; Chien-An A Hu; Gary Mlady; Steven C Eberhardt; Laurel O Sillerud Journal: AJR Am J Roentgenol Date: 2015-03 Impact factor: 3.959
Authors: A Rosati; C Tetta; J I Merello; I Palomares; R Perez-Garcia; F Maduell; B Canaud; P Aljama Garcia Journal: J Nephrol Date: 2014-08-05 Impact factor: 3.902
Authors: Dana C Miskulin; Navdeep Tangri; Karen Bandeen-Roche; Jing Zhou; Aidan McDermott; Klemens B Meyer; Patti L Ephraim; Wieneke M Michels; Bernard G Jaar; Deidra C Crews; Julia J Scialla; Stephen M Sozio; Tariq Shafi; Albert W Wu; Courtney Cook; L Ebony Boulware Journal: Clin J Am Soc Nephrol Date: 2014-10-15 Impact factor: 8.237
Authors: Abhijit V Kshirsagar; Janet K Freburger; Alan R Ellis; Lily Wang; Wolfgang C Winkelmayer; M Alan Brookhart Journal: Am J Med Date: 2013-04-15 Impact factor: 4.965
Authors: Adam E Gaweda; Yelena Z Ginzburg; Yossi Chait; Michael J Germain; George R Aronoff; Eliezer Rachmilewitz Journal: Nephrol Dial Transplant Date: 2014-05-12 Impact factor: 5.992