Iron Increases Dialysis Death Rate
ironjustice
Hemoglobin in Hemodialysis Patients.
Ibrahim HN, Foley RN, Zhang R, Gilbertson DT, Collins AJ
Clin J Am Soc Nephrol 2009 Feb 11.
BACKGROUND AND OBJECTIVES:
Use of parenteral iron for anemia management in dialysis patients has
greatly
increased.
Exceeding hemoglobin target levels is not without risk, and whether
parenteral
iron administration contributes to exceeding targets has not been
tested.
The authors aimed to determine prevalence of parenteral iron
administration
and its contribution to exceeding hemoglobin target levels.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:
The authors performed a retrospective observational study of 149,292
hemodialysis
patients using Centers for Medicaid & Medicare Services data.
All patients were point prevalent on January 1, 2004; survived through
June 30, 2004;
had Medicare as primary payer; were treated with erythropoiesis
stimulating agents
(ESAs); and had valid hemoglobin values in April, May, and June,
2004.
RESULTS:
Of the cohort, 58% received parenteral iron; use was more likely among
men, whites,
younger patients, and patients with end-stage renal disease as a
result of diabetes.
Age > 75 yr, African American and other races, baseline hemoglobin >
12 g/dl,
higher ESA dose, and iron use in months 1 to 4 of the study period
were independently
associated with the risk of exceeding hemoglobin levels of 12, 13, and
14 g/dl.
Receiving iron in month 4 of the study period showed the highest
probability of exceeding
targets (odds ratios 1.49, 1.43, 1.50 for hemoglobin levels 12, 13, 14
g/dl, respectively).
CONCLUSIONS:
Parenteral iron use is prevalent, and although adequate iron stores
are central to ESA
response, iron use may contribute to exceeding recommended hemoglobin
levels.
Only data from a prospective trial can confirm this association.
Clinical journal of the American Society of Nephrology : CJASN [Clin J
Am Soc Nephrol]
-----------------------
This article shows iron stores cause death by heart attack ..
"A value of 74 ms has been associated with risk for serious
arrhythmias related
to sudden death in dialysis patients.
A linear relationship showed that at 74 ms of QTc dispersion, TSAT was
35.2%"
Am J Kidney Dis. 2004 Oct;44(4):720-8. Related Articles, Links
The effect of iron stores on corrected QT dispersion in patients
undergoing
peritoneal dialysis.
Wu VC, Huang JW, Wu MS, Chin CY, Chiang FT, Liu YB, Wu KD.
Department of Internal Medicine, Far Eastern Memory Hospital, Taipei,
Taiwan.
BACKGROUND: Arrhythmia and sudden death represent striking features in
patients
with end-stage renal disease (ESRD). Increased QT dispersion has been
shown to
be associated with arrhythmias. Abnormal excitability and
heterogeneous cardiac
iron deposition may cause the arrhythmogenesis of human siderotic
heart
disease. Iron overload and precipitation with its toxicity in cardiac
muscles
may, therefore, cause QT prolongation in dialysis patients. METHODS: A
total of
102 (65 women, 37 men; mean age, 47.7 +/- 13.4 years) nondiabetic
patients
undergoing peritoneal dialysis (PD) were enrolled in this study.
Another 102
subjects with a serum creatinine level less than 1.5 mg/dL (133
micromol/L)
were used as matched control subjects. The PD patients were divided
into 2
groups according to whether their computerized measurements of
corrected QT
(QTc) dispersion were longer than 74 ms. A value of 74 ms has been
associated
with risk for serious arrhythmias related to sudden death in dialysis
patients.
RESULTS: The QTc dispersion of PD patients was significantly longer
than that
of the control subjects (69.8 +/- 40.0 versus 55.2 +/- 33.6 ms; P <
0.01).
Thirty-eight PD patients with QTc dispersion longer than 74 ms had
lower blood
pressure ( P = 0.01), fewer left ventricle masses ( P = 0.036), and
lower serum
albumin levels (P = 0.046) but higher levels of serum calcium (P =
0.038) and
transferrin saturation (TSAT; P = 0.022) than the other patients.
Multivariate
analysis identified TSAT as an independent factor for QTc dispersion
(r =
0.432, P < 0.001). A linear relationship showed that at 74 ms of QTc
dispersion, TSAT was 35.2%. CONCLUSION: Long-term PD patients have
longer QTc
dispersion than subjects with normal renal function. The high body
iron stores
in these patients increase the risk of increased QT dispersion. The
concern
over iron overload in dialysis patients is not only because of its
oxidative
toxicity, but also its precipitation of arrhythmias, which may be
measured by
the surrogate marker of QTc dispersion.
PMID: 15384024
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Tom
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anon...@nowhere.you.know
parenteral
iron administration contributes to exceeding targets has not been
tested.
The authors aimed to determine prevalence of parenteral iron
administration
and its contribution to exceeding hemoglobin target levels."
Ah, exceeding levels of iron, not iron itself is the problem.
ironj...@aol.com
Shteater ..
You've been told to take stay off my threads ..
Parenteral Iron Use: Possible Contribution to Exceeding Target
Hemoglobin in Hemodialysis Patients.
Ibrahim HN, Foley RN, Zhang R, Gilbertson DT, Collins AJ
Clin J Am Soc Nephrol 2009 Feb 11.
BACKGROUND AND OBJECTIVES:
Use of parenteral iron for anemia management in dialysis patients has
greatly
increased.
Exceeding hemoglobin target levels is not without risk, and whether
parenteral
iron administration contributes to exceeding targets has not been
tested.
The authors aimed to determine prevalence of parenteral iron
administration
and its contribution to exceeding hemoglobin target levels.
ironj...@aol.com
The
concern over iron overload in dialysis patients <<
"Massive iron deposits were found in the liver and spleen."
Hemosiderosis in hemodialysis patients. An autopsy study of 50 cases.
JAMA. 1980 Jul 25;244(4):343-5.
Ali M, Fayemi AO, Rigolosi R, Frascino J, Marsden T, Malcolm D.
The distribution of stainable iron stores was investigated in various
organs of 50 hemodialysis
patients with chronic renal disease.
Massive iron deposits were found in the liver and spleen.
Among 18 patients with severe hepatosplenic siderosis, iron deposits
were abundant in the
adrenal glands, lymph nodes, and lungs and were sparse in the heart,
kidneys, and pancreas.
There was an absence or scarcity of stainable iron in bone marrow of
19 pats.
In five of these marrow-iron-depleted patients, serum concentrations
of ferritin were high.
In long-term hemodialysis patients, a variety of factors make massive
iron overloads of various organs
a likely occurrence, severe hepatosplenic siderosis may occur in
marrow-iron-depleted patients, and
serum ferritin levels in this setting may not always accurately
reflect the status of marrow iron store.
PMID: 7392125
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Jesus Was A Vegetarian!
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ironjustice
wrote:
The concern over iron overload in dialysis patients <<
Labile iron in parenteral iron formulations and its potential for
generating plasma nontransferrin-bound iron in dialysis patients
Espósito B.P.; Breuer W.; Slotki I.; Cabantchik Z.I.
European Journal of Clinical Investigation, Volume 32,
Supplement 1, March 2002 , pp. 42-49
Abstract:
Background
Labile plasma iron (LPI) associated with iron supplementation has
been implicated in complications found in dialysis patients.
As LPI can potentially catalyse oxygen radical generation, we
determined the presence of labile iron in the parenteral preparations
and the frequency of occurrence of LPI in dialysis patients.
Design
The capacity to donate iron to apotransferrin (apo-) or to the
chelator desferrioxamine (DFO) was measured with
fluorescein-Tf (Fl-Tf) and Fl-DFO, respectively.
Those probes undergo quenching upon binding to iron.
Iron-catalysed generation of oxidant species was determined
with dihydrorhodamine.
Plasma nontransferrin-bound iron (NTBI), here termed LPI,
was determined by mobilization of iron from low-affinity binding
sites with oxalate, followed by its quantification with Fl-Tf in the
presence of Ga(III).
Results
Normal individuals and most (80%) dialysis patients,
analysed at least 1 week after iron supplementation
showed no detectable (<0·2 µm) LPI.
However, 20% of the patients (n = 71) showed significant
LPI levels (>0·2 µm), in some cases weeks after iron administration.
LPI levels correlated best (r2 = 0·9) with Tf saturation.
The iron preparations contained 2–6% low molecular weight and
redox-active iron, most of which is chelated by Tf.
Conclusions
Parenteral iron formulations contain a small but significant fraction
of redox-active iron, most of which is scavenged by apo-Tf within <1
h.
Therefore, oxidant stress associated with iron infusion is likely to
be transient.
The bulk of the polymeric iron is apparently inaccessible to apo-Tf.
Although LPI might return to normal within 2 h of intravenous iron
infusion,
the long-term persistence of low-level LPI in up to 20% of end stage
renal
disease (ESRD) patients indicates that complete clearance of the
intravenous
iron may be more protracted than originally estimated.
Keywords: Deferrioxamine; dialysis; free radicals; iron;
oxidative stress; transferrin
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>
> "Massiveirondeposits were found in the liver and spleen."
>
> Hemosiderosis in hemodialysis patients. An autopsy study of 50 cases.
> JAMA. 1980 Jul 25;244(4):343-5.
> Ali M, Fayemi AO, Rigolosi R, Frascino J, Marsden T, Malcolm D.
> The distribution of stainableironstores was investigated in various
> organs of 50 hemodialysis
> patients with chronic renal disease.
> Massiveirondeposits were found in the liver and spleen.
> Among 18 patients with severe hepatosplenic siderosis,irondeposits
> were abundant in the
> adrenal glands, lymph nodes, and lungs and were sparse in the heart,
> kidneys, and pancreas.
> There was an absence or scarcity of stainableironin bone marrow of
> 19 pats.
> In five of these marrow-iron-depleted patients, serum concentrations
> of ferritin were high.
> In long-term hemodialysis patients, a variety of factors make massiveironoverloads of various organs