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Abstract: TH-PO271

Iron Overload in Patients on Hemodialysis: Hepatic, Myocardial, and Bone Tissue Deposit

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Nunes, Lucas Acatauassu, Universidade de São Paulo, Belem, Brazil
  • Truyts, Cesar Augusto madid, university of sao paulo, Jacarei, Brazil
  • dos Reis, Luciene, University of Sao Paulo - Medical School - Nephrology Division, Sao Paulo, Brazil
  • Osorio, Rosse Carneiro, INCOR, Salvador, Brazil
  • Leao-Filho, Hilton M., Universidade de São Paulo, Belem, Brazil
  • Moyses, Rosa M.A., Universidade Nove de Julho, São Paulo, Brazil
  • Elias, Rosilene M., Universidade de Sao Paulo, Sao Paulo, Brazil
  • Rochitte, Carlos Eduardo, Heart Institute (InCor) University of São Paulo Medical School , São Paulo, Brazil
  • Jorgetti, Vanda, Universidade de Sao Paulo, Sao Paulo, Brazil
  • Custodio, Melani, Universidade de São Paulo, Belem, Brazil
Background

Anemia is commonly observed among ESRD patients on hemodialysis patients, most of the time requesting intravenous correction of iron deficiency (Fe). However, excessive Fe supplementation leads to increased risk of Fe overload with consequent deposition in organs and tissues such as liver, heart and bone tissue. The objective of the current study was to evaluate this issue in a cross-sectional cohort of ESRD on hemodialysis.

Methods

We included 28 adult patients (16 men), on hemodialysis for at least 3 months, and with serum ferritin levels ≥1,000 mg/l. Serum ferritin, transferrin saturation index (STI), Fe, C reactive protein (CRP), Calcium (Ca), phosphorus (P), parathyroid hormone (PTH) and alkaline phosphatase (AP) levels were recorded. T2* image acquisition of Magnetic Resonance Imaging (MRI) 1,5 Tesla, were used for the assessment of Fe of liver, and heart. R2* were used only of liver. Bone biopsy was also performed

Results

Mean age was was 54±13 years (57% men). Laboratorial values are depicted at the Table 1. T2* [Reference value(RV) > 16 ms] and R2* (RV < 60 s-1 ms) MRI of liver showed 6.95 ms [IQR 3.57] and 143.85 s-1 ms [IQR 84.52], respectively. MRI T2* of the heart did not show presence of Fe. Bone biopsy revealed that 100% of patients had Fe deposition.

Conclusion

These data detail the Fe distribution throughout the bone and liver but not myocardial in selected high-risk patients on hemodialysis (serum ferritin levels ≥1,000 ng/ml). The impact of Fe deposition on these tissues whether the use of chelation therapy would change this scenario should be evaluated in subsequent studies.

Table 1. Main baseline characteristics of patients
Hemoglobin, g/dl11.5 ± 3.5
Ferritin, ng/ml 1611 ± 599
Transferrin saturation index, %42 (25,75)
Fe100.5 ± 61.5
CRP, mg/L7.38 ± 6.74
Calcium, mg/dl 9.6 ± 0.7
Phosphorus, mg/dl5.1 ± 1.7
PTH, pg/ml 589 ± 809
Alkaline Fosfatase, U/L199 ± 220
Vitamin D, ng/ml 24.45 [9.775]
MRI Heart 
T2*, ms42.04 [11.33]