Impact of iatrogenic iron overload on the course of hepatitis C in the dialysis population: A plea for caution

Abstract

About 2.5% of the world population, corresponding to about 177 million individuals, are infected by hepatitis C virus (HCV), a small, single-stranded RNA virus. The prevalence of HCV infection among dialysis patients in Japan, Europe, and North America during the 2012 to 2015 period was found to be 8.7% in the DOPPS study. Nosocomial HCV spread in hemodialysis facilities still occurs. Increased hepatic tissue iron has been shown to play a deleterious role in the course of hepatitis C, favor development of fibrosis and cirrhosis and possibly increase the risk of liver cancer in the general population. Regular loss of blood in the hemodialysis circuit, in routine blood sampling for laboratory tests (for uremia monitoring), and in gut due to uremic enteropathy, invariably results in iron deficiency for which patients are commonly treated with intravenous (IV) iron preparations. Data on the effects of IV iron in hemodialysis patients with hepatitis C are limited (2 studies) and strongly suggest that parenteral iron may contribute to hepatocellular injury.Iatrogenic iron overload is extremely prevalent among hemodialysis population worldwide. Iron overload and toxicity has emerged as one of the most controversial topic in the management of anemia in dialysis patients. Given the known impact of iron in promoting growth and virulence of HCV and the associated liver disease, it is necessary to use iron therapy cautiously and closely monitor plasma markers of iron metabolism and liver iron stores non-invasively by means of MRI to avoid iron overload in this vulnerable population.

Iatrogenic iron overload and its potential consequences in patients on hemodialysis

“…The prevalence of HCV infection among dialysis patients in Japan, Europe and North America during the 2012-2015 period was found to be 8.7% in the DOPPS study and the propagation of nosocomial HCV in hemodialysis facilities still occurs [99]. Increased hepatic tissue iron has been shown to exert deleterious effects in the course of hepatitis C, favouring development of fibrosis and cirrhosis and possibly increasing the risk of liver cancer in the general population [99]. A deleterious influence of the hereditary hemochromatosis gene (HFE) mutations has also been shown in HCV infection.…”

“…Finally, hepatitis C infected-dialysis patients represent a population prone to ferrotoxicity. About 2.5% of the world's population, corresponding to about 177 million individuals, are infected by the hepatitis C virus (HCV), a small, single-stranded RNA virus [99]. The prevalence of HCV infection among dialysis patients in Japan, Europe and North America during the 2012-2015 period was found to be 8.7% in the DOPPS study and the propagation of nosocomial HCV in hemodialysis facilities still occurs [99].…”

“…About 2.5% of the world's population, corresponding to about 177 million individuals, are infected by the hepatitis C virus (HCV), a small, single-stranded RNA virus [99]. The prevalence of HCV infection among dialysis patients in Japan, Europe and North America during the 2012-2015 period was found to be 8.7% in the DOPPS study and the propagation of nosocomial HCV in hemodialysis facilities still occurs [99]. Increased hepatic tissue iron has been shown to exert deleterious effects in the course of hepatitis C, favouring development of fibrosis and cirrhosis and possibly increasing the risk of liver cancer in the general population [99].…”

“…A deleterious influence of the hereditary hemochromatosis gene (HFE) mutations has also been shown in HCV infection. Moreover, serum hepcidin level is suppressed and iron absorption is enhanced by HCV infection [99]. Data on the effects of IV iron in hemodialysis patients with hepatitis C are scarce (only 2 studies) but strongly suggest that parenteral iron may contribute to hepatocellular injury [99].…”

“…Data on the effects of IV iron in hemodialysis patients with hepatitis C are scarce (only 2 studies) but strongly suggest that parenteral iron may contribute to hepatocellular injury [99]. Given the known impact of iron in promoting growth and virulence of HCV and the associated liver disease, it is mandatory to use iron therapy cautiously and closely monitor plasma markers of iron metabolism and liver iron stores noninvasively by means of MRI to avoid iron overload in this vulnerable dialysis population [99].…”