title: Evidence for tissue iron overload in long-term hemodialysis patients and the impact of withdrawing parenteral iron.
abstract: OBJECTIVE
  Erythropoiesis in long-term hemodialyzed (LTH) patients is supported by erythropoietin (rHuEpo) and intravenous (IV) iron. This treatment may end up in iron overload (IO) in major organs. We studied such patients for the parameters of IO in the serum and in major organs.
  
  
  METHODS
  Patients were treated with rHuEpo (6-8 x 10(3) units × 1-3/wk) and IV 100 mg ferric saccharate.
  
  
  RESULTS
  Of 115 patients, 21 had serum ferritin (SF) > 1000 ng/mL. This group was further analyzed. Their SF and transferrin saturation (TSAT) were 2688 ± 1489 ng/mL and 54.2 ± 32.7%, respectively (vs. 125-360 ng/mL and 20-50% in normal controls). Serum hepcidin was 60.1 ± 29.5 nm (vs. 10.61 ± 6.44 nm in controls) (P < 0.001). Nineteen patients had increased malonyldialdehyde, a product of lipid peroxidation, indicating oxidative stress. T2* MRI disclosed in 19 of 21 patients moderate to severe IO in the liver and spleen, in three of eight patients in the pancreas, but in no patient in the heart. After stopping IV iron for a mean of 12 months, while continuing rHuEpo, the mean SF decreased in 11 patients to 1682 ng/mL and the mean TSAT decreased to 28%, whereas hemoglobin did not change indicating that tissue iron was utilized.
  
  
  CONCLUSIONS
  High SF correlates with IO in the liver and spleen, but not in the heart.
authors.affiliation: Department of Hematology, E Wolfson Medical Center, Holon, Israel.
authors.forename: Hussam
authors.initials: H
authors.lastname: Ghoti
authors.forename: Eliezer A
authors.initials: EA
authors.lastname: Rachmilewitz
authors.forename: Ramon
authors.initials: R
authors.lastname: Simon-Lopez
authors.forename: Raed
authors.initials: R
authors.lastname: Gaber
authors.forename: Zeev
authors.initials: Z
authors.lastname: Katzir
authors.forename: Eli
authors.initials: E
authors.lastname: Konen
authors.forename: Tamar
authors.initials: T
authors.lastname: Kushnir
authors.forename: Domenico
authors.initials: D
authors.lastname: Girelli
authors.forename: Natascia
authors.initials: N
authors.lastname: Campostrini
authors.forename: Eitan
authors.initials: E
authors.lastname: Fibach
authors.forename: Orly
authors.initials: O
authors.lastname: Goitein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004921:Erythropoietin / Q000008:administration & dosage; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D007501:Iron / Q000008:administration & dosage / Q000009:adverse effects; D019190:Iron Overload / Q000175:diagnosis* / Q000209:etiology*; D008099:Liver / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D010179:Pancreas / Q000473:pathology; D006435:Renal Dialysis / Q000009:adverse effects*; D013154:Spleen / Q000473:pathology
chemical_list: D004921:Erythropoietin; D005293:Ferritins; D007501:Iron