Iron Overload in Patients on Maintenance Hemodialysis

Bregman, H; Gelfand, Michael

doi:10.1177/039139888100400203

Cited by 14 publications

(11 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We have found a normal logarithmic distribution of SF in our population, as has been previously reported [2,10,22,24]. Statistical analysis of SF values is therefore performed after their conversion into natural logarithms.…”

Section: Statisticssupporting

confidence: 84%

“…Patients on chronic hemodialysis (HD) may develop hemochromatosis as a result of multiple blood transfu sions and intravenous iron therapy [1][2][3][4], In 1980, Bregman et al [9,10] reported cases of proximal myopathy related to iron overload in HD patients with a high incidence of the HLA antigens A3, B7 or BI4. These antigens, specially A3, have been often found associated with idiopathic hemochromatosis [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…These antigens, specially A3, have been often found associated with idiopathic hemochromatosis [5][6][7][8]. Elevated serum ferritin (SF) and high tissue iron content have also been detected in H D patients carrying these antigens [9][10][11][12][13][14], These findings have not been obtained consistently [15], however, and several aspects of the problem have not yet been analyzed. It is not known whether this relation between high SF levels and HLA A3, B7 or B14, is also present in chronic renal failure (CRF) patients on conser vative treatment.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

HLA Antigens and Serum Ferritin in Hemodialysis Patients

Quereda¹,

Teruel²,

Lamas³

et al. 1987

Nephron

View full text Add to dashboard Cite

The evolution of serum ferritin levels in Ill chronic-hemodialysis patients is prospectively studied. Patients were classified in two groups according to the presence or absence of’hemochromatosis antigens’ (HLA A3, B7 or B14) in their HLA typing. Levels of serum ferritin were similar in both groups before they started dialysis and during the first year. On the contrary, in the second and third hemodialysis years serum ferritin was higher in the group carrying ‘hemochromatosis antigens’. These differences were observed in patients treated with parenteral iron either in the form of transfusions or as intravenous dextran-iron but not in patients receiving oral iron. We conclude that the risk of developing iron overload is greater in hemodialysis patients with HLA A3, B7 or B14. Nevertheless, this potential risk can be minimized with a restrictive policy on the use of parenteral iron (transfusions, intravenous dextran-iron).

show abstract

Section: Statisticssupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

HLA Antigens and Serum Ferritin in Hemodialysis Patients

Quereda¹,

Teruel²,

Lamas³

et al. 1987

Nephron

View full text Add to dashboard Cite

show abstract

“…The perception of toxicity of therapeutic Fe in CKD patients is based largely on a limited number of observational studies reporting an increased infection rate in Fe-deficient subjects on Fe replacement (25) or in CKD patients with high ferritin concentrations (26) and increased CVD and death in dialysis patients (27,28). Serum ferritin was shown to correlate with LIC assessed noninvasively by a superconducting quantum interference device (17).…”

Section: Discussionmentioning

confidence: 99%

Serum Iron Markers Are Inadequate for Guiding Iron Repletion in Chronic Kidney Disease

Ferrari

Kulkarni

Dheda

et al. 2011

Clinical Journal of the American Society of Nephrology

124

128

View full text Add to dashboard Cite

Summary Background and objectives Iron (Fe) overload may complicate parenteral Fe therapy used to enhance the efficacy of erythropoietic-stimulating agents in the treatment of anemia of chronic kidney disease. However, serum Fe markers are influenced by inflammation or malignancy and may not accurately reflect the amount of body Fe. Design, setting, participants, & measurements We studied the relationship between parenteral Fe therapy, conventional serum Fe markers, and liver iron concentration (LIC) measured using magnetic resonance R2 relaxometry (FerriScan) in 25 Fe-deficient predialysis chronic kidney disease patients before and 2 and 12 weeks after single high-dose intravenous Fe and in 15 chronic hemodialysis patients with elevated serum ferritin (>500 μg/L). Results In predialysis patients, there was strong dose dependency between the administered Fe dose and changes in LIC at weeks 2 and 12; however, no dose dependency between Fe dose and changes in ferritin or transferrin saturation (TSAT) were observed. In hemodialysis patients, LIC correlated with the cumulative Fe dose and duration of dialysis but not with current ferritin or TSAT. The cumulative Fe dose remained a significant independent predictor of LIC in a multiple regression model. Two dialysis patients who received >6 g parenteral Fe had substantially elevated LIC >130 μmol/g, which is associated with hemochromatosis. Conclusions In Fe-deficient predialysis patients, intravenous Fe therapy is associated with increases in LIC unrelated to changes in conventional Fe markers. In hemodialysis patients, TSAT and ferritin are poor indicators of body Fe load, and some patients have LICs similar to those found in hemochromatosis.

show abstract

“…There are several reasons for this so-called "iron apprehension": (i) A clinical trial that was performed almost three decades ago in 137 Fe-deficient individuals in Somalia showed that the risk for infection in those who received Fe supplementation was almost five times higher than those who received placebo (63); (ii) in the pre-ESA era, there have been frequent reports about the risk and consequences of Fe overload as a result of blood transfusion or Fe administration to anemic dialysis patients (64,65); (iii) several in vitro studies have indicated the association between Fe supplementation and oxidative stress in cell cultures (66,67); and (iv) a limited number of observational studies have indicated an association between high serum ferritin and infection (65,68) or mortality (52) and between Fe administration and indices of cardiovascular disease (69) or death risk (70) in dialysis patients.…”

Section: The "Iron Apprehension"mentioning

confidence: 99%

The Fascinating but Deceptive Ferritin

Kalantar‐Zadeh

Kalantar‐zadeh

Lee

2006

Clinical Journal of the American Society of Nephrology

172

162

View full text Add to dashboard Cite

Although the emergence of erythropoiesis-stimulating agents has revolutionized the anemia management of chronic kidney disease (CKD) in the past two decades, strategies to assess iron (Fe) status and to provide Fe supplementation have remained indistinct. The reported cases of hemochromatosis in dialysis patients from the pre-erythropoiesis-stimulating agent era along with the possible associations of Fe with infection and oxidative stress have fueled the "iron apprehension." To date, no reliable marker of Fe stores in CKD has been agreed on. Serum ferritin continues to be the focus of attention. Almost half of all maintenance hemodialysis patients have a serum ferritin >500 ng/ml. In this ferritin range, Fe supplementation currently is not encouraged, although most reported hemochromatosis cases had a serum ferritin >2000 ng/ml. The moderate-range hyperferritinemia (500 to 2000 ng/ml) seems to be due mostly to non-Fe-related conditions, including inflammation, malnutrition, liver disease, infection, and malignancy. Recent epidemiologic studies have shown that a low, rather than a high, serum Fe is associated with a poor survival in maintenance hemodialysis patients. In multivariate adjusted models that mitigate the confounding effect of malnutrition-inflammation, serum ferritin <1200 ng/ml and Fe saturation ratio in 30 to 50% range are associated with the greatest survival in maintenance hemodialysis patients. Although ferritin is a fascinating molecule, moderate hyperferritinemia is a misleading marker of Fe stores in patients with CKD. It may be time to revisit the utility of serum ferritin in CKD and ask ourselves whether its measurement has helped us or has caused more confusion and controversy.

show abstract

Iron Overload in Patients on Maintenance Hemodialysis

Cited by 14 publications

References 8 publications

HLA Antigens and Serum Ferritin in Hemodialysis Patients

HLA Antigens and Serum Ferritin in Hemodialysis Patients

Serum Iron Markers Are Inadequate for Guiding Iron Repletion in Chronic Kidney Disease

The Fascinating but Deceptive Ferritin

Contact Info

Product

Resources

About