Abstract: SA-PO814

Labile Plasma Iron for the Early Detection of Iron Overload in ESRD

Session Information

Category: Dialysis

  • 605 Dialysis: Anemia and Iron Metabolism

Authors

  • Benaya, Alon, shaare zedek, Jerusalem, Israel
  • Slotki, Itzchak N., Share Zedek Medical Center, Jerusalem, Israel
  • Shavit, Linda, Shaare Zedek Medical Center, Jerusalem, Israel
  • Malyszko, Jolanta, Medical University, Bialystok, Poland
Background

The increased usage of intravenous iron (IVI) in hemodialysis patients during recent years has led to increasing concern over the potential development of iron overload (IO). Current methods for detecting iron overload, transferrin saturation (TSAT) and serum ferritin are neither sensitive nor specific. Labile plasma iron (LPI) represents a component of non-transferrin bound iron that is both redox active and chelatable and may be a more accurate indicator of impending iron overload. We studied whether LPI measured using the FeROS LPI detecting system (Aferrix) can serve as an early indicator of impending IO in hemodialysis patients.

Methods

Chronic hemodialysis patients from two medical centers in Israel and Poland who received IVI were included. Demographic data, cause of ESRD, comorbidities, medications and the following laboratory parameters were recorded: Hb, serum iron, transferrin, TSAT, ferritin. LPI was measured before and 48 hours after a single IV administration of either iron sucrose 100 mg, iron gluconate 62.5 mg, iron (III)-hydroxide dextran complex 100 mg. A test result of 0.6 units of LPI or more indicated a potential for iron-mediated production of reactive oxygen species in the sample.

Results

111 hemodialysis patients, aged 64 ± 15, were included in the study. 90 patients received iron sucrose, 14 iron gluconate and 7 iron dextran at mean monthly doses of 233 ± 133 mg; LPI was negative in all patients prior to IVI, but became positive post administration in 4 patients, all of whom received iron sucrose. Three of these were diabetic, had TSAT <30% and ferritin <360 ng/ml and received monthly iron doses of 400-500 mg.

Conclusion

Doses of IVI routinely used in chronic hemodialysis patients appear to be safe. However, higher monthly doses may be associated with detectable LPI post administration, even in the absence of currently used laboratory parameters of IO.