Abstract
Introduction 
 Iron overload is one of the most controversial topics in the management of anemic dialysis patients. Parenteral iron supplementation is commonly prescribed to hemodialysis (HD) patients but less frequently to peritoneal dialysis (PD) patients. Moreover, ferritin targets are far lower and more physiological in PD than in HD.
 Methods
 We compared the liver iron concentration (LIC) measured by means of Signal-Intensity ratio (SIR) magnetic resonance imaging (MRI) according to Rennes University method in a cohort of 32 PD patients living in the Paris region published in 2017, with two cohorts of French HD patients studied in the same way (119 patients reported in 2012 and 80 further patients reported in 2014).
 Results
 Normal hepatic iron load (LIC ≤ 50 µmol/g of dry weight) was observed in 81.3% of the 32 PD patients (CI: 64.3-91.5%), as compared to only 16% (CI: 10.4-23.7%) in the first HD cohort and 35% (CI: 25.4-45.9%) in the second HD cohort (p<0.0001 for both comparisons; X2 test). Mild iron overload (50 < LIC ≤ 100 µmol/g) was found in 5 PD patients and severe overload (LIC > 200 µmol/g) in only one PD patient (who had received IV iron) (3.1%; CI: 0-17.1%). Conversely, severe iron overload was found in 30.3% of patients in the first HD cohort (CI: 22.7-39%) and 11.3% of those in the second HD cohort (CI: 5.8-20.2%) (p= 0.0033 versus the first HD cohort, X2 test).
 Conclusion
 Contrary to hemodialysis patients, iron overload is rare and mostly mild in peritoneal dialysis patients.
Highlights
La surcharge martiale est l’un des sujets les plus controversés dans la prise en charge de l’anémie des patients dialysés
We compared the liver iron concentration (LIC) measured by means of Signal-Intensity ratio (SIR) magnetic resonance imaging (MRI) according to Rennes University method in a cohort of 32 peritoneal dialysis (PD) patients living in the Paris region published in 2017, with two cohorts of French HD patients studied in the same way (119 patients reported in 2012 and 80 further patients reported in 2014)
Severe iron overload was found in 30.3% of patients in the first HD cohort (CI: 22.7-39%) and 11.3% of those in the second HD cohort (CI: 5.8-20.2%) (p= 0.0033 versus the first HD cohort, X2 test)
Summary
La surcharge martiale est l’un des sujets les plus controversés dans la prise en charge de l’anémie des patients dialysés. L’utilisation de fer par voie intraveineuse (IV) chez les patients en HD a considérablement augmenté dans le monde, au cours des quinze dernières années, en raison de sa facilité d’utilisation et de son action rapide et efficace par rapport aux préparations orales, pour traiter la carence martiale vraie et sa capacité à surmonter la carence fonctionnelle en fer, souvent rencontrée dans les cas d’IRT [1,2,3,4,5,6]. La recommandation de 2012 du Kidney Disease Improving Global Outcomes (KDIGO) a fixé la limite supérieure de ferritine à 500 μg/L pour les patients hémodialysés, en soulignant le risque de carence fonctionnelle en fer pendant le traitement par ASE, ainsi que la capacité du fer par voie intraveineuse, à éviter l’utilisation des ASE et ses effets indésirables [4]. Ces recommandations de bonne pratique qui sont largement suivies par les néphrologues du monde entier, ont clairement contribué à l’utilisation accrue de fer par voie parentérale chez les patients hémodialysés au cours de la dernière décennie [5, 6]
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