- 作者：Guy Rostoker ; Mireille Griuncelli ; Christelle Loridon ; Renaud Couprie ; Abbes Benmaadi ; Catherine Bounhiol ; Myriam Roy ; Gabrielle Machado ; Phillippe Janklewicz ; Gilles Drahi ; Herv¨¦ Dahan ; Yves Cohen
- 关键词：Hemodialysis ; Hemosiderosis ; Hepatic MRI ; Hepcidin ; Parenteral iron
- 刊名：The American Journal of Medicine
- 出版年：2012
- 出版时间：October, 2012
- 年：2012
- 卷：125
- 期：10
- 页码：991-999.e1
- 全文大小：1245 K
Background
Most dialysis patients receiving erythropoesis-stimulating agents (ESA) also receive parenteral iron supplementation. There are few data on the risk of hemosiderosis in this setting.Methods
We prospectively measured liver iron concentration by means of T1 and T2* contrast magnetic resonance imaging (MRI) without gadolinium, in a cohort of 119 fit hemodialysis patients receiving both parenteral iron and ESA, in keeping with current guidelines.
Results
Mild to severe hepatic iron overload was observed in 100 patients (84 % ; confidence interval, [CI] 76 % -90 % ), of whom 36 % (CI, 27 % -46 % ) had severe hepatic iron overload (liver iron concentration >201 ¦Ìmol/g of dry weight). In the cross-sectional study, infused iron, hepcidin, and C-reactive protein values correlated with hepatic iron stores in both univariate analysis (P < .05, Spearman test) and binary logistic regression (P <.05). In 11 patients who were monitored closely during parenteral iron therapy, the iron dose infused per month correlated strongly with both the overall increase and the monthly increase in liver iron concentration (respectively, rho = 0.66, P = .0306 and rho = 0.85, P = 0.0015, Spearman test). In the 33 patients with iron overload, iron stores fell significantly after iron withdrawal or after a major reduction in the iron dose (first MRI: 220 ¦Ìmol/g (range: 60-340); last MRI: 50 ¦Ìmol/g (range: 5-210); P <.0001, Wilcoxon's paired test).
Conclusions
Most hemodialysis patients receiving ESA and intravenous iron supplementation have hepatic iron overload on MRI. These findings call for a revision of guidelines on iron therapy in this setting, especially regarding the amount of iron infused and noninvasive methods for monitoring iron stores.