BACKGROUND: Most dialysis patients receiving erythropoesis-stimulating agents (ESA) also receive parenteral iron supplementation. There are few data on the risk of hemosiderosis in this setting. METHODS: We prospectively measured liver iron concentration by means of T1 and T2* contrast magnetic resonance imaging (MRI) without gadolinium, in a cohort of 119 fit hemodialysis patients receiving both parenteral iron and ESA, in keeping with current guidelines. RESULTS: Mild to severe hepatic iron overload was observed in 100 patients (84%; confidence interval, [CI] 76%-90%), of whom 36% (CI, 27%-46%) had severe hepatic iron overload (liver iron concentration >201 μmol/g of dry weight). In the cross-sectional study, infused iron, hepcidin, and C-reactive protein values correlated with hepatic iron stores in both univariate analysis (P<.05, Spearman test) and binary logistic regression (P <.05). In 11 patients who were monitored closely during parenteral iron therapy, the iron dose infused per month correlated strongly with both the overall increase and the monthly increase in liver iron concentration (respectively, rho=0.66, P=.0306 and rho=0.85, P=0.0015, Spearman test). In the 33 patients with iron overload, iron stores fell significantly after iron withdrawal or after a major reduction in the iron dose (first MRI: 220 μmol/g (range: 60-340); last MRI: 50 μmol/g (range: 5-210); P <.0001, Wilcoxon's paired test). CONCLUSIONS: Most hemodialysis patients receiving ESA and intravenous iron supplementation have hepatic iron overload on MRI. These findings call for a revision of guidelines on iron therapy in this setting, especially regarding the amount of iron infused and noninvasive methods for monitoring iron stores.
BACKGROUND: Most dialysis patients receiving erythropoesis-stimulating agents (ESA) also receive parenteral iron supplementation. There are few data on the risk of hemosiderosis in this setting. METHODS: We prospectively measured liver iron concentration by means of T1 and T2* contrast magnetic resonance imaging (MRI) without gadolinium, in a cohort of 119 fit hemodialysis patients receiving both parenteral iron and ESA, in keeping with current guidelines. RESULTS: Mild to severe hepatic iron overload was observed in 100 patients (84%; confidence interval, [CI] 76%-90%), of whom 36% (CI, 27%-46%) had severe hepatic iron overload (liver iron concentration >201 μmol/g of dry weight). In the cross-sectional study, infused iron, hepcidin, and C-reactive protein values correlated with hepatic iron stores in both univariate analysis (P<.05, Spearman test) and binary logistic regression (P <.05). In 11 patients who were monitored closely during parenteral iron therapy, the iron dose infused per month correlated strongly with both the overall increase and the monthly increase in liver iron concentration (respectively, rho=0.66, P=.0306 and rho=0.85, P=0.0015, Spearman test). In the 33 patients with iron overload, iron stores fell significantly after iron withdrawal or after a major reduction in the iron dose (first MRI: 220 μmol/g (range: 60-340); last MRI: 50 μmol/g (range: 5-210); P <.0001, Wilcoxon's paired test). CONCLUSIONS: Most hemodialysis patients receiving ESA and intravenous iron supplementation have hepatic iron overload on MRI. These findings call for a revision of guidelines on iron therapy in this setting, especially regarding the amount of iron infused and noninvasive methods for monitoring iron stores.
Authors: Navdeep Tangri; Dana C Miskulin; Jing Zhou; Karen Bandeen-Roche; Wieneke M Michels; Patti L Ephraim; Aidan McDermott; Deidra C Crews; Julia J Scialla; Stephen M Sozio; Tariq Shafi; Bernard G Jaar; Klemens Meyer; L Ebony Boulware Journal: Nephrol Dial Transplant Date: 2014-11-02 Impact factor: 5.992
Authors: David M Charytan; Amy Barton Pai; Christopher T Chan; Daniel W Coyne; Adriana M Hung; Csaba P Kovesdy; Steven Fishbane Journal: J Am Soc Nephrol Date: 2014-12-26 Impact factor: 10.121
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