Abstract:
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.
The American Journal of Medicine
