title: Maximal standard dose of parenteral iron for hemodialysis patients: an MRI-based decision tree learning analysis.
abstract: OBJECTIVE
  Iron overload used to be considered rare among hemodialysis patients after the advent of erythropoesis-stimulating agents, but recent MRI studies have challenged this view. The aim of this study, based on decision-tree learning and on MRI determination of hepatic iron content, was to identify a noxious pattern of parenteral iron administration in hemodialysis patients.
  
  
  METHODS
  We performed a prospective cross-sectional study from 31 January 2005 to 31 August 2013 in the dialysis centre of a French community-based private hospital. A cohort of 199 fit hemodialysis patients free of overt inflammation and malnutrition were treated for anemia with parenteral iron-sucrose and an erythropoesis-stimulating agent (darbepoetin), in keeping with current clinical guidelines. Patients had blinded measurements of hepatic iron stores by means of T1 and T2* contrast MRI, without gadolinium, together with CHi-squared Automatic Interaction Detection (CHAID) analysis.
  
  
  RESULTS
  The CHAID algorithm first split the patients according to their monthly infused iron dose, with a single cutoff of 250 mg/month. In the node comprising the 88 hemodialysis patients who received more than 250 mg/month of IV iron, 78 patients had iron overload on MRI (88.6%, 95% CI: 80% to 93%). The odds ratio for hepatic iron overload on MRI was 3.9 (95% CI: 1.81 to 8.4) with >250 mg/month of IV iron as compared to <250 mg/month. Age, gender (female sex) and the hepcidin level also influenced liver iron content on MRI.
  
  
  CONCLUSIONS
  The standard maximal amount of iron infused per month should be lowered to 250 mg in order to lessen the risk of dialysis iron overload and to allow safer use of parenteral iron products.
authors.affiliation: Division of Nephrology and Dialysis, Hôpital Privé Claude Galien, Générale de Santé, 20 route de Boussy, 91480 Quincy sous Sénart, France.
authors.forename: Guy
authors.initials: G
authors.lastname: Rostoker
authors.affiliation: Division of Nephrology and Dialysis, Hôpital Privé Claude Galien, Générale de Santé, 20 route de Boussy, 91480 Quincy sous Sénart, France.
authors.forename: Mireille
authors.initials: M
authors.lastname: Griuncelli
authors.affiliation: Division of Nephrology and Dialysis, Hôpital Privé Claude Galien, Générale de Santé, 20 route de Boussy, 91480 Quincy sous Sénart, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Loridon
authors.affiliation: Division of Nephrology and Dialysis, Hôpital Privé Claude Galien, Générale de Santé, 20 route de Boussy, 91480 Quincy sous Sénart, France.
authors.forename: Théophile
authors.initials: T
authors.lastname: Magna
authors.affiliation: Division of Radiology, Hôpital Privé Claude Galien, Générale de Santé, 20 route de Boussy, 91480 Quincy sous Sénart, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Janklewicz
authors.affiliation: Division of Radiology, Hôpital Privé Claude Galien, Générale de Santé, 20 route de Boussy, 91480 Quincy sous Sénart, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Drahi
authors.affiliation: Division of Radiology, Hôpital Privé Claude Galien, Générale de Santé, 20 route de Boussy, 91480 Quincy sous Sénart, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Dahan
authors.affiliation: Division of Radiology, Hôpital Privé Claude Galien, Générale de Santé, 20 route de Boussy, 91480 Quincy sous Sénart, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000188:drug therapy; D003430:Cross-Sectional Studies; D000068256:Darbepoetin alfa / Q000627:therapeutic use; D003661:Decision Support Techniques; D003663:Decision Trees; D005260:Female; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D007263:Infusions, Parenteral; D007501:Iron / Q000008:administration & dosage / Q000009:adverse effects* / Q000032:analysis; D019190:Iron Overload / Q000139:chemically induced*; D008099:Liver / Q000737:chemistry; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D055815:Young Adult
chemical_list: D006397:Hematinics; D000068256:Darbepoetin alfa; D007501:Iron