Abstract | BACKGROUND AND OBJECTIVES:
Iron overload used to be considered rare among hemodialysis patients after the advent of erythropoesis-stimulating agents, but recent MRI studies have challenged this view. The aim of this study, based on decision-tree learning and on MRI determination of hepatic iron content, was to identify a noxious pattern of parenteral iron administration in hemodialysis patients. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: We performed a prospective cross-sectional study from 31 January 2005 to 31 August 2013 in the dialysis centre of a French community-based private hospital. A cohort of 199 fit hemodialysis patients free of overt inflammation and malnutrition were treated for anemia with parenteral iron-sucrose and an erythropoesis-stimulating agent (darbepoetin), in keeping with current clinical guidelines. Patients had blinded measurements of hepatic iron stores by means of T1 and T2* contrast MRI, without gadolinium, together with CHi-squared Automatic Interaction Detection (CHAID) analysis. RESULTS: The CHAID algorithm first split the patients according to their monthly infused iron dose, with a single cutoff of 250 mg/month. In the node comprising the 88 hemodialysis patients who received more than 250 mg/month of IV iron, 78 patients had iron overload on MRI (88.6%, 95% CI: 80% to 93%). The odds ratio for hepatic iron overload on MRI was 3.9 (95% CI: 1.81 to 8.4) with >250 mg/month of IV iron as compared to <250 mg/month. Age, gender (female sex) and the hepcidin level also influenced liver iron content on MRI. CONCLUSIONS: The standard maximal amount of iron infused per month should be lowered to 250 mg in order to lessen the risk of dialysis iron overload and to allow safer use of parenteral iron products.
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Authors | Guy Rostoker, Mireille Griuncelli, Christelle Loridon, Théophile Magna, Philippe Janklewicz, Gilles Drahi, Hervé Dahan, Yves Cohen |
Journal | PloS one
(PLoS One)
Vol. 9
Issue 12
Pg. e115096
( 2014)
ISSN: 1932-6203 [Electronic] United States |
PMID | 25506921
(Publication Type: Journal Article)
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Chemical References |
- Hematinics
- Darbepoetin alfa
- Iron
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Topics |
- Adult
- Aged
- Aged, 80 and over
- Anemia
(drug therapy)
- Cross-Sectional Studies
- Darbepoetin alfa
(therapeutic use)
- Decision Support Techniques
- Decision Trees
- Female
- Hematinics
(therapeutic use)
- Humans
- Infusions, Parenteral
- Iron
(administration & dosage, adverse effects, analysis)
- Iron Overload
(chemically induced)
- Liver
(chemistry)
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Prospective Studies
- Renal Dialysis
- Young Adult
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