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Evidence for tissue iron overload in long‐term hemodialysis patients and the impact of withdrawing parenteral iron
Author(s) -
Ghoti Hussam,
Rachmilewitz Eliezer A.,
SimonLopez Ramon,
Gaber Raed,
Katzir Zeev,
Konen Eli,
Kushnir Tamar,
Girelli Domenico,
Campostrini Natascia,
Fibach Eitan,
Goitein Orly
Publication year - 2012
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/j.1600-0609.2012.01783.x
Subject(s) - transferrin saturation , hepcidin , medicine , gastroenterology , hemoglobin , ferritin , oxidative stress , spleen , erythropoietin , hemodialysis , phlebotomy , lipid peroxidation , anemia , endocrinology , surgery , iron deficiency
Background/aims Erythropoiesis in long‐term hemodialyzed ( LTH ) patients is supported by erythropoietin (r H u E po) and intravenous ( IV ) iron. This treatment may end up in iron overload ( IO ) in major organs. We studied such patients for the parameters of IO in the serum and in major organs. Methods Patients were treated with r H u E po (6–8 x 10 3 units × 1–3/wk) and IV 100 mg ferric saccharate. Results Of 115 patients, 21 had serum ferritin ( SF ) > 1000 ng/mL. This group was further analyzed. Their SF and transferrin saturation ( TSAT ) were 2688 ± 1489 ng/mL and 54.2 ± 32.7%, respectively (vs. 125–360 ng/mL and 20–50% in normal controls). Serum hepcidin was 60.1 ± 29.5 n m (vs. 10.61 ± 6.44 n m in controls) ( P < 0.001). Nineteen patients had increased malonyldialdehyde, a product of lipid peroxidation, indicating oxidative stress. T 2* MRI disclosed in 19 of 21 patients moderate to severe IO in the liver and spleen, in three of eight patients in the pancreas, but in no patient in the heart. After stopping IV iron for a mean of 12 months, while continuing rHuE po, the mean SF decreased in 11 patients to 1682 ng/mL and the mean TSAT decreased to 28%, whereas hemoglobin did not change indicating that tissue iron was utilized. Conclusion High SF correlates with IO in the liver and spleen, but not in the heart.