Analysis of liver iron concentration in an elderly female undergoing hemodialysis with calcific uremic arteriolopathy does not support the role of iron overload in calciphylaxis: lesson for the clinical nephrologist

Rostoker, Guy; Senet, Patricia; Lepeytre, Fanny; Griuncelli, Mireille; Loridon, Christelle; Rabaté, Clémentine; Cohen, Yves

doi:10.1007/s40620-020-00904-z

Cited by 4 publications

(6 citation statements)

References 10 publications

(27 reference statements)

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Section: Discussionmentioning

confidence: 99%

“…Iron overload was once thought to be uncommon in hemodialysis patients, but it is currently becoming a more common clinical condition. Recent quantitative MRI studies clearly imply a relationship between IV iron dosage and the risk of iron overload, bringing existing biomarker cutoffs and clinical recommendations into doubt, particularly regarding recommended iron doses 23,24 …”

Section: Discussionmentioning

confidence: 99%

“…Recent quantitative MRI studies clearly imply a relationship between IV iron dosage and the risk of iron overload, bringing existing biomarker cutoffs and clinical recommendations into doubt, particularly regarding recommended iron doses. 23,24 Furthermore, several recent observational studies have revealed that high IV iron levels may increase cardiovascular events and overall mortality in kidney failure patients on hemodialysis. [25][26][27][28] This newly identified unfavorable impact of IV iron has resulted in significant and constant revisions in the idea and practical approach to IV iron replacement in dialysis patients.…”

Section: Discussionmentioning

confidence: 99%

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The prevalence of cardiac and hepatic iron overload in patients with kidney failure: A protocol for systematic review and meta‐analysis

Nashwan

Yassin

Abd‐Alrazaq

et al. 2022

Health Science Reports

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Introduction Few studies have reported cardiac and hepatic iron overload in patients with kidney failure or end‐stage renal disease and the current evidence regarding the prevalence is still scarce. To the best of the authors' knowledge and following an exhaustive search; no systematic review/meta‐analysis has estimated the aggregated prevalence of cardiac and hepatic iron overload in this patient population. Aim This review aims to estimate the prevalence of hepatic and/or cardiac iron overload in patients with kidney failure who are receiving hemodialysis, peritoneal dialysis, or underwent kidney transplants. Methods A systematic review with meta‐analysis will be conducted and reported in line with PRISMA guidelines. MEDLINE and Embase bibliographic databases will be searched using a comprehensive list of controlled vocabularies and keywords to identify relevant studies. All studies reporting the prevalence of hepatic and/or cardiac iron overload prevalence in patients with kidney failure will be considered. Risk of bias assessment for included studies will be conducted based on the study design. StataBE v17 and MetaXL v5.3 will be utilized to perform the meta‐analysis. Discussion The findings of this systematic review and analysis are expected to give information on the prevalence of iron overload among patients with kidney failure, which will optimize interventions and guide future research in this understudied field.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The prevalence of cardiac and hepatic iron overload in patients with kidney failure: A protocol for systematic review and meta‐analysis

Nashwan

Yassin

Abd‐Alrazaq

et al. 2022

Health Science Reports

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“…Liver hepatocytes are the main storage site for body iron and interestingly, Rostoker et al [ 22 ] found that on analysis of liver iron concentration (LIC) in 358 dialysis patients, measured by quantitative magnetic resonance imaging (qMRI), 243 dialysis patients had mild, moderate or severe radiologic iron overload, of which only one patient with mild LIC overload developed CUA. There were no reported cases of CUA in any of the patients with normal, moderate or severe levels of LIC.…”

Section: Role Of Iron In Calciphylaxismentioning

confidence: 99%

“…Consequently, stopping iron treatment could result in worsened patient outcomes and result in more harm than good. An alternative to this as suggested by Rostoker et al [ 22 ] may not require iron cessation, but instead close monitoring of liver iron storage via qMRI, which is the most important organ for iron storage [ 16 ].…”

Section: Role Of Iron In Calciphylaxismentioning

confidence: 99%

The Role of Iron in Calciphylaxis—A Current Review

Wickens

Rengarajan

Chinnadurai

et al. 2022

JCM

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Calcific uraemic arteriolopathy (CUA), also known as calciphylaxis, is a rare and often fatal condition, frequently diagnosed in end-stage renal disease (ESRD) patients. Although exact pathogenesis remains unclear, iron supplementation is suggested as a potential risk factor. Iron and erythropoietin are the main stay of treatment for anaemia in ESRD patients. Few observational studies support the role of iron in the pathogenesis of calciphylaxis although data from the pivotal trial was not strongly supportive of this argument, i.e., no difference in incidence of calciphylaxis between the low-dose and high-dose iron treatment arms. Elevated levels of vascular cell adhesion molecules in association with iron excess were postulated to the pathogenesis of CUA by causing inflammation and calcification within the microvasculature. In-addition, oxidative stress generated because of iron deposition in cases of systemic inflammation, such as those seen in ESRD, may play a role in vascular calcification. Despite these arguments, a direct correlation between cumulative iron exposure with CUA incidence is not clearly demonstrated in the literature. Consequently, we do not have evidence to recommend iron reduction or cessation in ESRD patients that develop CUA.

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Fluindione

2021

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Calciphylaxis: case reportAn 88-year-old woman developed calciphylaxis during treatment with long-term anticoagulant fluindione [duration of treatment to reaction onset not stated].The woman, who had end stage kidney disease related to diabetic nephropathy with idiopathic membranous nephropathy, initiated on haemodialysis in August 2016. Her medical history included type 2 diabetes mellitus since the age of 54 years, which was complicated due to mild sensitive polyneuritis of the lower limbs and mild diabetic retinopathy. Additional medical history included diastolic cardiac insufficiency and atrial fibrillation since 2016 with high risk of thromboembolic events for which she was on long-term anticoagulation with a vitamin-K antagonist fluindione [fuindione; route and dosage not stated]. She had no general or dialysis complications, except for vascular access surgery failure until June 2019, when she developed extensive painful ulcers on both the legs. Her ulcers were further preceded by erysipelas-like lesions.The woman underwent multidisciplinary management with hospitalisation in a geriatric unit (from 23 rd August 2019 to 25 th March 2020) with pain relief by unspecified opioids and pregabalin, daily wound cleaning and intensification of dialysis by Expanded Hemodialysis with sodium thiosulfate. On 24 th July 2019, fluindione therapy was stopped as it was considered to be responsible for calciphylaxis as a drug-related adverse event. Calcium dialysate levels 1.5 mmol remained unchanged. On 14 October 2019, she underwent successful split-thickness skin graft; and subsequently, on 14 October 2019, second successful split-thickness skin graft was performed in the hospital. Liver iron concentration were slightly elevated observed on signal intensity ratio MRI and R2 relaxometry. In November 2019, her lower limb pain disappeared, and unspecified opioids discontinued on 12 November 2019 and pregabalin was discontinued on 18 November 2019. On 10 December 2019, dermatology consultation suggested 90% healing of leg ulcers, and sodium thiosulfate was discontinued. Then, complete healing of the leg ulcers was confirmed on subsequent dermatology consultation on 10 March 2020, and she was discharged home at the end of March 2020. She started receiving anticoagulation with danaparoid [danaparoid-sodium], which was later replaced with rivaroxaban and heparin during dialysis sessions 28 January 2020. On 16 July 2020, she was referred for a dermatology consultation, where calciphylaxis was confirmed based on deep dermal biopsy. Laboratory investigation of biochemical marker showed decrease levels of serum calcium and serum bone alkaline phosphatase and elevated levels of serum phosphate, serum parathyroid hormone, serum ferritin and serum c-reactive protein. Serum iron biomarkers levels were closed to anaemia as per European statement for anaemia management.Rostoker G, et al. Analysis of liver iron concentration in an elderly female undergoing hemodialysis with calcific uremic arteriolopathy does not support the role of iron ...

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Analysis of liver iron concentration in an elderly female undergoing hemodialysis with calcific uremic arteriolopathy does not support the role of iron overload in calciphylaxis: lesson for the clinical nephrologist

Cited by 4 publications

References 10 publications

The prevalence of cardiac and hepatic iron overload in patients with kidney failure: A protocol for systematic review and meta‐analysis

The prevalence of cardiac and hepatic iron overload in patients with kidney failure: A protocol for systematic review and meta‐analysis

The Role of Iron in Calciphylaxis—A Current Review

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