<b>Intravenous Iron Therapy as a Possible Risk Factor for Atherosclerosis in End-stage Renal Disease</b>

Abstract

SUMMARYAtherosclerosis is a disease of the arterial wall, with increasing wall thickness representing an early event in the progression of the disease. It has been suggested that iron overload, as assessed by increased serum ferritin concentration, may be a risk factor for atherosclerosis.The aim of this study was to investigate the relationship between the influence of intravenous (IV) iron therapy and ferritin levels and carotid intima media thickness (C-IMT) in dialysis patients. Sixty patients (51 ± 14) years were divided into two groups according to their IMT obtained by ultrasound; group I (high risk) and group II (low risk). The parameters assessed were serum creatinine, urea, calcium, phosphorus, hemoglobin, albumin, uric acid, iron, ferritin, and lipid levels. Thirty-eight patients (88%) in group I and 5 patients (12%) in group II received IV iron therapy while 5 patients (29%) in group I and 12 patients (71%) in group II (P < 0.001) did not receive IV iron therapy. Ferritin levels were higher in group I than in group II (581 ± 303 and 306 ± 224) (P < 0.001). C-IMT measurements correlated with serum ferritin and with the intravenous iron dose received during the 24 months preceding the study (r = 0.315, P = 0.015; r = 0.471, P = 0.001).The findings indicate that IV iron therapy and elevated serum ferritin levels may cause an increase in the incidence of atherosclerosis. (Int Heart J 2005; 46: 255-264)

New Options for Iron Supplementation in Maintenance Hemodialysis Patients

“…Although IV iron preparations are effective, their indiscriminate use can have serious adverse consequences that may go undetected in short-term clinical trials. As described in a recent review, 9 use of IV iron preparations can increase the risk for infection, 10,11 cause oxidative stress, [12][13][14][15][16][17][18][19] promote cardiovascular disease, 11,[20][21][22][23][24] and lead to iron overload. [25][26][27][28] In addition, some IV iron preparations cause life-threatening anaphylactic reactions in susceptible individuals.…”

Safety Issues in Iron Treatment in CKD

“…23,24 Carotid artery media-intima thickness, a marker of atherosclerosis, may be associated with the annual cumulative dose of IV iron preparations in ESRD patients. 25,26 Also, the severity of atherosclerotic lesions has been shown to be greater in patients with carotid lesions who had received long-term IV iron preparations. 26 Rabbits fed a high-cholesterol diet accumulate iron in the atherosclerosis plaques, 27,28 and atherosclerotic lesions in apolipoprotein E-deficient mice contain significant amounts of iron.…”

“…25,26 Also, the severity of atherosclerotic lesions has been shown to be greater in patients with carotid lesions who had received long-term IV iron preparations. 26 Rabbits fed a high-cholesterol diet accumulate iron in the atherosclerosis plaques, 27,28 and atherosclerotic lesions in apolipoprotein E-deficient mice contain significant amounts of iron. 28 Iron accumulation also is higher in abdominal aortic aneurysm walls compared with non-aortic aneurysm walls.…”

A One-Year Study of the Antiatherosclerotic Effect of the Angiotensin-II Receptor Blocker Losartan in Hypertensive Patients A Comparison With Angiotensin-Converting Enzyme Inhibitors

“…[9][10][11][12] A thickened common carotid IMT has been useful to monitor the extent and progression of atherosclerosis 13,14) since it reflects atherosclerosis of not only the carotid arteries but also the coronary arteries, providing the atherosclerotic dynamics are characteristically similar in both these areas. 15,16) The reduction of carotid IMT is well-documented in cholesterol lowering therapy.…”