Iron Storage Indices: Novel Predictors of Bacteremia in Hemodialysis Patients Initiating Intravenous Iron Therapy

Abstract

Bacterial sepsis is the second leading cause of death among hemodialysis (HD) patients. Iron overload and intravenous iron therapy are linked to bacterial infection. This study examined iron stores, intravenous iron dosing, and bacteremic risk in HD patients. Retrospectively, 132 HD patients receiving their first course of intravenous iron were studied. Baseline laboratory values, including transferrin saturation (TSAT) value and ferritin level, were measured before initiating intravenous iron therapy. Patients were followed for up to 1 year after the initiation of iron therapy for the outcome of bacteremia by Cox proportional hazards regression analysis. Iron-replete patients (those with a TSAT value > or =20% and a ferritin level > or =100 ng/mL) had a significantly higher risk of bacteremia (hazard ratio [HR], 2.5). Venous catheter users (HR, 4.9) and those with diabetes mellitus (HR, 2.2) were also at increased risk. Modest iron storage levels may increase the risk of bacteremia among HD patients initiating intravenous iron therapy. Additional studies are needed to confirm these relationships.

Modulation of Iron Metabolism and Hepcidin Release by HFE Mutations in Chronic Hemodialysis Patients: Pathophysiological and Therapeutic Implications

“…An updated mortality curve for cardiovascular disease and infection in 127 Italian CHD patients subdivided according to the presence or not of the C282Y and H63D HFE mutations is shown in figure 1. It is worthy of note that, in patients negative for HFE mutations, we observed a higher mortality due to sepsis, previously associated with a higher iron dosage (Jean, Charra et al 2002;Teehan, Bahdouch et al 2004), and due to cardiovascular disease, possibly linked to hypertension and thromboembolic events related to ESAs (Miyashita, Tojo et al 2004;Phrommintikul, Haas et al 2007) and oxidative stress related to iron (Valenti, Valenti et al 2007). Fig.…”

“…As mentioned above, although treatment with ESAs and IV iron formulations (Locatelli, Aljama et al 2004) are generally prescribed, functional iron deficiency is a common finding, determining the need for high doses of ESAs and iron, both associated with adverse events. Indeed, high ESAs doses have been associated with mortality due to cardiovascular events related to hypertension and hypercoagulability (Miyashita, Tojo et al 2004;Phrommintikul, Haas et al 2007;Strippoli, Tognoni et al 2007), whereas excess iron promotes vascular damage by inducing oxidative stress, and heightens the risk of infections (Seifert, von Herrath et al 1987;Jean, Charra et al 2002;Teehan, Bahdouch et al 2004;Kalantar-Zadeh, Regidor et al 2005;Valenti, Valenti et al 2007). The mechanism proposed to explain refractoriness to IV iron was previously related to the inhibition of erythropoiesis and iron recycling from macrophages by inflammation (Stenvinkel 2003).…”

HFE Mutations Modulate the Effect of Iron on Serum Hepcidin-25 in Chronic Hemodialysis Patients

“…Functional iron deficiency is a common finding, determining the need for high doses of ESAs and iron, both associated with adverse events. High doses of ESAs increase the risk of mortality due to cardiovascular events related to hypertension and hypercoagulability (9 -11), whereas excess iron promotes vascular damage by inducing oxidative stress and heightens the risk of infections (12)(13)(14)(15)(16). The mechanism proposed to explain refractoriness to i.v.…”

Modern Aspects of Diagnosis and Treatment of Anemia in Rheumatoid Arthritis Patients

“…Разграничение АХЗ и ЖДА имеет важное практиче-ское значение: некорректная трактовка пациента с АХЗ как имеющего дефицит железа влечет за собой неэффек-тивную терапию железом с риском развития осложнений (перегрузка железом) [73]. Несмотря на то что при АХЗ кроветворение характеризуется недостаточной доступно-стью железа, мнения о целесообразности терапии железом этих больных неоднозначны.…”

“…Несмотря на то что при АХЗ кроветворение характе-ризуется недостаточной доступностью железа, суждения о целесообразности терапии железом этих больных неод-нозначны [36,73,76]. При сопутствующем абсолютном де-фиците железа и смешанном характере анемии больным рекомендуется дополнительно назначать препараты желе-за.…”