harmful iron overload in dialysis patients



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Kidney Int. 2004 Mar;65(3):1091-8. Related Articles, Links

Validation of serum ferritin values by magnetic susceptometry in predicting iron overload in
dialysis patients.

Canavese C, Bergamo D, Ciccone G, Longo F, Fop F, Thea A, Martina G, Piga A.

Department of Internal Medicine, Section of Nephrology, Department of Pediatric Science and Unit of
Cancer Epidemiology of the University of Torino, S. Giovanni Molinette Hospital and OIRM-CTO
Hospital, Torino, Italy.

Background. Guidelines for treating anemia in dialysis patients accept, as high-end range of serum
ferritin useful to optimize erythropoietin therapy, values high as 500 to 900 microg/L, on the
hypothesis that ferritin might be not representative of iron overload. Methods. A superconducting
quantum interference device (SQUID) was used to make direct noninvasive magnetic measurements of
nonheme hepatic iron content in 40 dialysis patients treated with intravenous iron, and liver iron
content was compared with biochemical markers of iron status. Results. Only 12/40 (30%) patients
showed normal hepatic iron content (SQUID <400 microg/g), while 32.5% had mild (400 to 1000
microg/g) and 37.5% severe (>1000 microg/g) iron overload, although 28/40 patients (70%) had serum
ferritin below 500 microg/L. Among many parameters, hepatic iron content was only correlated with
ferritin (r= 0.324, P= 0.04). The receiver operating characteristic (ROC) analysis showed the best
specificity/sensitivity ratio to identify iron overload for ferritin >340 microg/L (W = 0.716).
Multivariate logistic regression analysis demonstrated that an increase in serum ferritin of 100
microg/L and female gender were independent variables associated with moderate to severe hepatic
iron overload: OR 1.71 (95% CI 1.10 to 2.67) and OR 10.68 (95% CI 1.81 to 63.15), respectively.
Conclusion. Hepatic iron overload is frequent in dialysis patients with ferritin below currently
proposed high-end ranges, and the diagnostic power of ferritin in indicating true iron stores is
better than presumed. Safety concerns should prompt a reevaluation of acceptable iron parameters,
focusing on potential gender-specific differences, to avoid potentially harmful iron overload in a
majority of dialysis patients, mainly females.

PMID: 14871430 [PubMed - in process]

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