Hemodialysis-associated Hemosiderosis in the Era of Erythropoiesis-stimulating Agents: A MRI Study

Rostoker, Guy; Griuncelli, Mireille; Loridon, Christelle; Couprie, R.; Benmaadi, A.; Bounhiol, Catherine; Roy, Myriam; Machado, Gabrielle; Janklewicz, Phillippe; Drahi, Gilles; Dahan, H.; Cohen, Yves

doi:10.1016/j.amjmed.2012.01.015

Cited by 146 publications

(281 citation statements)

References 32 publications

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“…Most hemodialysis patients receiving ESA and IVI supplementation have excessive hepatic iron on magnetic resonance imaging. 44,45 In a study that closely followed guidelines for ESA administration and iron supplementation, 80% of the patients had excessive iron in the liver on magnetic resonance imaging and 30% had severe liver iron overload. 45 A 2009 study including 96 hemodialysis patients using bone marrow biopsy showed that most patients with ferritin levels of .500 ng/ml had higher levels of C-reactive protein and an increased content of bone marrow iron.…”

Section: Assessment Of Iron Storesmentioning

confidence: 99%

“…44,45 In a study that closely followed guidelines for ESA administration and iron supplementation, 80% of the patients had excessive iron in the liver on magnetic resonance imaging and 30% had severe liver iron overload. 45 A 2009 study including 96 hemodialysis patients using bone marrow biopsy showed that most patients with ferritin levels of .500 ng/ml had higher levels of C-reactive protein and an increased content of bone marrow iron. 46 In short, the most widely used indices to assess iron stores are currently insufficient to reliably distinguish patients likely to benefit from IVI from those with iron overload.…”

Section: Assessment Of Iron Storesmentioning

confidence: 99%

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Considerations and Challenges in Defining Optimal Iron Utilization in Hemodialysis

Charytan

Pai

Chan

et al. 2015

Journal of the American Society of Nephrology

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Trials raising concerns about erythropoiesis-stimulating agents, revisions to their labeling, and changes to practice guidelines and dialysis payment systems have provided strong stimuli to decrease erythropoiesis-stimulating agent use and increase intravenous iron administration in recent years. These factors have been associated with a rise in iron utilization, particularly among hemodialysis patients, and an unprecedented increase in serum ferritin concentrations. The mean serum ferritin concentration among United States dialysis patients in 2013 exceeded 800 ng/ml, with 18% of patients exceeding 1200 ng/ml. Although these changes are broad based, the wisdom of these practices is uncertain. Herein, we examine influences on and trends in intravenous iron utilization and assess the clinical trial, epidemiologic, and experimental evidence relevant to its safety and efficacy in the setting of maintenance dialysis. These data suggest a potential for harm from increasing use of parenteral iron in dialysisdependent patients. In the absence of well powered, randomized clinical trials, available evidence will remain inadequate for making reliable conclusions about the effect of a ubiquitous therapy on mortality or other outcomes of importance to dialysis patients. Nephrology stakeholders have an urgent obligation to initiate well designed investigations of intravenous iron in order to ensure the safety of the dialysis population.

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Section: Assessment Of Iron Storesmentioning

confidence: 99%

Section: Assessment Of Iron Storesmentioning

confidence: 99%

Considerations and Challenges in Defining Optimal Iron Utilization in Hemodialysis

Charytan

Pai

Chan

et al. 2015

Journal of the American Society of Nephrology

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“…Recent data based on MRI suggest that a substantial fraction of CHD patients receiving Epo and intravenous iron supplementation have hepatic iron overload [19,36]. This illustrates the need for updating guidelines on the amount of iron infused in these patients which may promote not only organ damage, but also a vicious cycle because of increased hepcidin production and ensuing iron maldistribution, without improving anemia.…”

Section: Potential Clinical Usefulness Of Hepcidin Determination In Cmentioning

confidence: 99%

Hepcidin levels in chronic hemodialysis patients: a critical evaluation

Valenti

Pelusi

Campostrini

et al. 2014

Clinical Chemistry and Laboratory Medicine

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Altered systemic iron metabolism is a key element of uremia, and functional iron deficiency mainly related to subclinical inflammation makes it difficult to maintain proper control of anemia in chronic hemodialysis patients (CHD). In the last decade, the hepatic hormone hepcidin has been progressively recognized as the master regulator of circulating iron levels through the modulation of cellular iron fluxes in response to iron stores, as well as to erythroid and inflammatory stimuli. Hepcidin is cleared by the kidney and progression of renal disease has been associated to increased serum hepcidin levels. This, in turn, reduces iron availability for erythropoiesis, suggesting anti-hepcidin strategies for improving anemia control. Moreover, hepcidin has been recently implicated in the pathogenesis of long-term complications of dialysis, like accelerated atherosclerosis. Initial studies almost invariably reported a sustained increase of serum hepcidin in chronic hemodialysis patients. Noteworthy, such studies included relatively few patients and controls that were poorly matched for major determinants of serum hepcidin at population level, i.e., age and gender. More recent data based on accurately matched larger series challenge the view that hepcidin is intrinsically increased in hemodialysis patients, showing a marked inter-and intra-individual variability of hormone levels. Here we take a critical look to the data published so far on hepcidin levels in CHD, analyze the reasons underlying the discrepancies in available studies and the hepcidin variability in CHD, and point out the need for further studies in large series of well-characterized CHD patients and controls.

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“…They further showed that serum ferritin values exceeding 340 µg/L were associated with iron overload. Similarly Ferrari et al 72 and Rostoker et al 73 recently showed a dramatic increase of liver iron contents approaching those found in hemochromatosis with routine administration of IV iron preparations in hemodialysis patients. It thus is clear that iron overload commonly occurs in ESRD patients treated with ESAs and IV iron according to the currently accepted guidelines.…”

Section: Potential Adverse Effects Of IV Iron On the Livermentioning

confidence: 72%

Safety Issues in Iron Treatment in CKD

Vaziri

2016

Seminars in Nephrology

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Hemodialysis-associated Hemosiderosis in the Era of Erythropoiesis-stimulating Agents: A MRI Study

Cited by 146 publications

References 32 publications

Considerations and Challenges in Defining Optimal Iron Utilization in Hemodialysis

Considerations and Challenges in Defining Optimal Iron Utilization in Hemodialysis

Hepcidin levels in chronic hemodialysis patients: a critical evaluation

Safety Issues in Iron Treatment in CKD

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