Hepatic iron overload is likely present in many patients with chronic kidney disease (CKD) patients at dialysis initiation, according to a new study presented at the European Renal Association-European Dialysis and Transplant Association 53rd Congress in Vienna.

Patricia Carrilho, MD, of Hospital Fernando Fonseca in Amadora, Portugal, and colleagues used hepatic magnetic resonance imaging (MRI) to determine the liver iron content of 17 patients starting maintenance hemodialysis (HD) at their institution. They also measured levels of hemoglobin, ferritin, and transferrin saturation and evaluated patients’ history of transfusion and receipt of intravenous (IV) iron and erythropoiesis-stimulating agents (ESAs).

Results showed that 35% of patients had received IV iron at a median dose of 450 mg prior to starting HD. The same proportion (35%) previously received transfusion of packed red blood cells at a median dose of 2.5 packs, and 65% were on ESA therapy.

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Hepatic MRI revealed that only 18% of patients had normal liver iron (50 µmol/g or less) at the start of HD, according to calculations based on Gandon’s formula. More than half (59%) already displayed mild iron overload (51-100 µmol/g) and 23% moderate overload (101-200 µmol/g). Although severe overload (more than 201 µmol/g) is common among HD patients, none of the patients in this study reached that extreme.

The investigators examined demographic factors, clinical variables, and biochemical markers for possible correlations with hepatic iron levels and found none. “These findings suggest iron administration to CKD patients should be cautious,” Dr Carrilho and colleagues concluded.

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1. Carrilho P, Santiago I, Fidalgo P, and Alves M. Assessment of Liver Iron Content by Magnetic Resonance in Chronic Kidney Disease at the Start of Maintenance Hemodialysis. Nephrol Dial Transplant. 31:i198 doi:10.1093/ndt/gfw166.17.