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 μmol/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 μmol/g (range: 60-340); last MRI: 50 μmol/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.

译文

背景:大多数接受促红细胞生成素(ESA)治疗的透析患者也接受肠胃外补铁。在这种情况下,有关铁血黄素沉着症风险的数据很少。
方法:我们按照119例患者的标准,通过无without的T1和T2 *对比磁共振成像(MRI),对119名接受肠胃外注射铁和ESA的健康血液透析患者进行了前瞻性测量。
结果:在100例患者中观察到轻至重度肝铁超负荷(84%;置信区间,[CI] 76%-90%),其中36%(CI,27%-46%)有严重肝铁超负荷(肝)铁浓度> 201μmol/ g干重)。在横断面研究中,在单变量分析(P <.05,Spearman检验)和二元逻辑回归(P <.05)中,注入的铁,铁调素和C反应蛋白值均与肝铁储量相关。在肠胃外铁疗期间接受密切监测的11例患者中,每月输注的铁剂量与肝铁浓度的总体增加和每月增加密切相关(分别为rho = 0.66,P = .0306和rho = 0.85,P = 0.0015,Spearman检验)。在33名铁超负荷患者中,铁撤出或铁剂量大幅减少后铁存储显着下降(首次MRI:220μmol/ g(范围:60-340);最后MRI:50μmol/ g(范围:) 5-210); P <.0001,Wilcoxon配对测试)。
结论:大多数接受ESA和静脉补铁的血液透析患者的MRI显示肝铁超负荷。这些发现要求在这种情况下修订铁疗法指南,尤其是关于铁的注入量和用于监测铁储存的非侵入性方法。

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