Iron Overload in Haemodialysis Patients Increases the Risk of Bacteraemia: A Prospective Study

Abstract

The incidence of bacteraemia in relation to the degree of transfusional iron overload was studied prospectively in patients from one haemodialysis unit over a 2-year period, with a total follow-up of 181.3 patient-years in 158 patients. Every 3 months, the patients were classified according to the serum ferritin in one of three groups: less than 500, 500-1000 or greater than 1000 micrograms/l. Twenty-nine episodes of bacteraemia were recorded over 181.3 patient-years (yearly incidence of 0.160). The yearly incidence of bacteraemia was 0.1173 and 0.1101 for ferritin less than 500 and 500-1000 micrograms/l (no significant difference), with a cumulative incidence for both groups of 0.1164. In the ferritin greater than 1000 micrograms/l group, the incidence was 0.3404 (P less than or equal to 0.005 versus the ferritin less than or equal to 1000 micrograms/l group). After stratification for patient's age (at inclusion in the study) and duration of haemodialysis therapy, the higher incidence of bacteraemia in the ferritin greater than 1000 versus less than or equal to 1000 micrograms/l groups persisted (P less than or equal to 0.005). This prospective study confirms previous retrospective studies in showing that acquired transfusional iron overload in haemodialysis is associated with a greater risk of bacteraemia.

Serum ferritin and survival of renal transplant recipients: a prospective 10-year cohort study

“…Furthermore, iron overload in our patients was due to excessively administered iron rather than hereditary Patients with excessively high serum ferritin levels died from various causes, due to the widespread organ dysfunction caused by iron overload [27,351. Indeed, iron overload has been associated with an increased risk of severe infection [3,12,29,36, 401, cardiovascular disease [34, 391, and malignancy [19, 23, 421. The increased susceptibility to infection, and the increased proliferation of malignant cells in iron overload may be due to depressed phagocytic function of neutrophils and to impaired cell-mediated immunity [30,42,431.…”

A rare case of enteric and systemic Yersinia enterocolitica infection in a chronic, not iron-overloaded dialysis patient

“…Septicaemia with Y. enterocolitica is rare, and it is most often seen in patients who have a predisposing disease, or receiving an iron-chelating therapy, or are in an acute iron-overloaded state (16). Iron has a critical role in bacteria for multiplication in the host, and iron overload impairs the phagocytic activity of neutrophils (6,8,30). Y. enterocolitica strains have the ability to increase their virulence using iron provided in the environment during iron supplementation therapy.…”

“…Furthermore, iron-chelating agents and blood transfusions were not administered. Conversely, different studies have reported sepsis caused by Y. enterocolitica in dialyzed patients with mild or high iron overload, iron-chelating treatment or multiple blood transfusions (1,8,12,26).…”

“…Iron is an essential growth factor of bacteria for multiplication in the host, and, on the contrary, evidences showed that iron supplementation is harmful for the host defence mechanisms, oxygen transport, deoxy ribonucleotide synthesis, and redox reactions (6,28,35). In haemodialysis patients, various authors reported high incidence of iron-overload (8,13,26). Y. enterocolitica requires iron for growth and it is able to accelerate the proliferation using exogenous chelators as source of iron in patients showing an iron-overloaded state or receiving an iron-chelating therapy (6,13,26,28).…”

The Prevalence of HCV Infection in Hemodialysis Population and Compared ELISA and PCR Methods for Detecting of HCV Infection

“…Hemodialysis is the 5th most common procedure for patients aged 45 -64 years (1,2). Due to the fact that the procedure of hemodialysis requires prolonged vascular access, patients undergoing chronic hemodialysis are at increased risk of blood-transmitted infections (3). The risk of infection is related to several factors including environmental factors such as contaminated devices, equipment and supplies, environmental surfaces, and personnel's hands (4,5), as well as patient related factors such as the number of years spent on dialysis therapy (dialytic age), partial immunosuppressant, regular hospitalizations, and parenteral interventions frequency (6)(7)(8).…”