Potential risk for infection and atherosclerosis due to iron therapy

Sengoelge, Gürkan; Sunder‐Plassmann, Gere; Hörl, Walter H.

doi:10.1053/j.jrn.2004.09.018

Cited by 28 publications

(18 citation statements)

References 70 publications

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“…Moreover, there were a broad range of causes of death in group 1, including heart failure, infection, malignant tumor, and myocardial infarction. Iron deficiency exacerbates heart failure [30], reduces immune response [12,31], and induces carcinogenesis [32,33]. Therefore, it would seem better to avoid excessively low s-ft levels.…”

Section: Discussionmentioning

confidence: 99%

“…However, excess iron produces strong oxidative stress through the Fenton reaction, which underlies the onset of various pathological processes, including arteriosclerosis [7,8,9], myocardial infarction [10], infection [11,12], and malignant tumors [13,14]. Moreover, such oxidative stress caused by IV iron administration has also been reported in HD patients [7,15,16], suggesting that excess iron in the body due to frequent iron administration may affect the prognosis of these patients.…”

Section: Introductionmentioning

confidence: 99%

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Low Levels of Serum Ferritin Lead to Adequate Hemoglobin Levels and Good Survival in Hemodialysis Patients

et al. 2014

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Background: The optimal level of serum ferritin (s-ft) for anemia control and good survival in hemodialysis (HD) patients remains unclear. A 10-year survey was performed to clarify the appropriate quantities of s-ft and investigate the relationships among s-ft, transferrin saturation (TSAT), and mortality in HD patients. Methods: HD outpatients (n = 125) treated with erythropoiesis-stimulating agents (ESA) were followed for 10 years. The ESA and low-dose iron supplement dosages were adjusted to maintain the hemoglobin (Hb) at 10-11 g/dl, according to Japanese guidelines. The Kaplan-Meier method, log-rank tests, and the Cox proportional hazards model were used for performing the statistical analyses. The interactions among the Hb, s-ft, and TSAT were analyzed using a multiple linear regression model. Patients with TSAT ≥20% were classified according to the s-ft cutoff values: group 1 (s-ft <30 ng/ml); group 2 (s-ft 30-80 ng/ml); group 3 (s-ft >80 ng/ml); TSAT <20% was a predictor of poor outcome. Results: The survival rate in group 2 was significantly higher than that in other groups (p = 0.013), and the Cox proportional hazards model analysis showed a good effect of low levels of s-ft on patients' survival. The multiple linear regression model showed a strong effect of s-ft on the Hb (log [s-ft], β-coefficient −0.45: 95% confidence interval −0.65 to −0.26, p < 0.001). Conclusion: This study revealed that low levels of s-ft have a beneficial effect on the outcome of HD patients receiving ESA. Thus, the optimal s-ft level might be lower than that established previously for these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Low Levels of Serum Ferritin Lead to Adequate Hemoglobin Levels and Good Survival in Hemodialysis Patients

et al. 2014

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“…Anemia of chronic disease (ACD), which is tightly linked to an insufficient iron supply for erythropoiesis, is often associated with reduced physical and mental function and poor quality of life [2]. Iron overload has also been suspected to be associated with a variety of complications, including infection and endothelial dysfunction [3]. …”

Section: Introductionmentioning

confidence: 99%

Importance of Ferritin for Optimizing Anemia Therapy in Chronic Kidney Disease

et al. 2010

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The clinical significance of serum ferritin in monitoring the iron status of patients on maintenance hemodialysis (MHD) has become suspected. In this review, we reassess the interpretation of high serum ferritin values in such patients, with the goal of treating their anemia in a safe way. From the observations that (1) H-ferritin gene transcription is predominantly active in inflammatory conditions, whereas L-ferritin is induced only after exposure to very high iron concentrations and is preferentially secreted to plasma from hepatocytes; (2) the expression of both types of ferritin proteins are exclusively dependent on intracellular free iron, which is often sequestered by LPS or cytokines in several cell types, and (3) splenic iron is depleted and serum ferritin does not increase in the combined conditions of both inflammation and iron deficiency, it is deduced that elevated serum ferritin levels are caused by the accumulation of intracellular iron, especially reticuloendothelial cells or macrophages, hepatocytes, and other cells, while cytokines or inflammation might modulate the relative ratio of ferritin to body iron storage. Therefore, high levels of serum ferritin in patients on MHD can be used to indicate iron deposition in most cells, including vascular and immunocompetent cells, and is still a reliable indicator of the need to withhold iron administration.

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“…Both would have been opportunities to introduce contamination into the lines, and both would have resulted increased iron stores, yet only the iron infusion resulted in an increase in CRS. That may be related to the fact that intravenous iron therapy may result in nontransferrin-bound iron [18]. Although human cells have many ways of importing iron, the free ionic iron concentration in the human body is usually kept at a very low level to limit bacterial growth [19].…”

Section: Discussionmentioning

confidence: 99%

Is Systemic Heparin a Risk Factor for Catheter-Related Sepsis in Dialysis Patients?

et al. 2007

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Background: Biofilms are dense aggregates of surface adherent microorganisms embedded in a polysaccharide matrix. Intravenous iron and heparin are thought to promote the formation of biofilm. Both are commonly employed during hemodialysis treatments which might affect the incidence of catheter-related sepsis. Methods: 559 patients who underwent hemodialysis treatment with a catheter were reviewed. Episodes of sepsis were analyzed for the use of systemic heparin and intravenous iron as well as all other risk factors for sepsis. Results: Sepsis developed in 141 of the 796 catheters. Analysis of variance revealed that the number of days that the catheter remained in place was the most significant variable (p < 0.0001) associated with catheter-related sepsis along with multiple other variables, but a Cox proportional hazards analysis revealed that only the two biofilm risk factors (intravenous iron [p < 0.001], and mid-treatment bolus of heparin [p = 0.046]) along with previously reported factor of a depressed serum albumin (p = 0.001) are of significance. Conclusion: In addition to duration of catheter use, we found three significant risk factors for sepsis and two of those three have been associated with the development of biofilm.

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Potential risk for infection and atherosclerosis due to iron therapy

Cited by 28 publications

References 70 publications

Low Levels of Serum Ferritin Lead to Adequate Hemoglobin Levels and Good Survival in Hemodialysis Patients

Low Levels of Serum Ferritin Lead to Adequate Hemoglobin Levels and Good Survival in Hemodialysis Patients

Importance of Ferritin for Optimizing Anemia Therapy in Chronic Kidney Disease

Is Systemic Heparin a Risk Factor for Catheter-Related Sepsis in Dialysis Patients?

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