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Abstract: FR-PO735

The Total IV Iron Burden and Insulin Sensitivity in ESRD

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Cho, Monique E., University of Utah, Salt Lake City, Utah, United States
  • Hansen, Jared, Veterans Health Administration, Salt Lake City, Utah, United States
  • Lavasani, Iran, University of Utah, Salt Lake City, Utah, United States
  • Muniyappa, Ranganath, NIDDK, NIH, Bethesda, Maryland, United States
Background

Systemic iron overload has been strongly associated with increased incidence of diabetes in non-CKD patient populations. Despite the high prevalence iron overload in hemodialysis (HD) patients due to frequent IV iron infusion, there are no studies to evaluate the association between total accumulative IV iron dose and insulin sensitivity.

Methods

We performed an observational pilot study of prevalent hemodialysis patients at University of Utah (N=16). Patients with history of dementia, chronic hepatitis, steroid use, malignancy, thalassemia, hemochromatosis, sickle cell disease, hospitalization or IV antibiotic use within one month of screening were excluded. The total accumulative dose of IV iron for the entire duration of dialysis was calculated for each participant. All 16 participants underwent 3-hour oral glucose tolerance test to calculate whole-body insulin sensitivity (Matsuda Index, MI). The total accumulative IV iron dose was log transformed to enable parametric analysis with Pearson correlation coefficient to evaluate its association with MI.

Results

The study group was diverse (8 Hispanics, 4 Whites, 1 Asian, and 3 mixed), with 9 men and 7 women. Half of the group had diabetes. The mean±SD values for age, dialysis duration, systolic blood pressure, hemoglobin, and albumin were 52±14 years, 7.4±5.8 years, 142±28 mmHg, 10.6±1.9 g/dL, and 3.9±0.2 mg/dL, respectively. The median (IQR) transferrin saturation and ferritin were 28 (21, 39)% and 652 (300, 971) ng/mL. The median (IQR) total IV iron dose over the mean HD duration was 10,825 (6,986, 16675) mg (range of 2,400 to 29,748 mg). The insulin sensitivity as assessed by MI showed a significant inverse relationship with the total IV iron dose (r = -0.50, Figure 1).

Conclusion

This is the first study to evaluate the association between IV iron therapy and insulin sensitivity and to suggest a possible role of IV iron therapy in metabolic risk in HD patients. Larger studies are required to confirm the result and to further investigate the underlying mechanisms.

Funding

  • Private Foundation Support