Abstract
Optimal ferritin level in hemodialysis patients between Japan and other countries is controversial. Long-term side effects of iron supplementation in these patients remain unclear. We aimed to elucidate whether past hyperferritinemia in hemodialysis patients was associated with high risk of death and cerebrovascular and cardiovascular diseases (CCVDs). This small retrospective cohort study included approximately 44 patients unintentionally supplemented with excessive intravenous iron. A significantly higher risk of CCVDs was observed in patients with initial serum ferritin levels ≥1000 ng/mL than in the remaining patients. High ferritin levels slowly decreased to <300 ng/mL in a median of 24.2 (10.5–46.5) months without treatment. However, compared with the remaining patients, only patients whose ferritin levels did not decrease to <300 ng/mL steadily had a significantly higher risk of all-cause death (hazard ratio, 9.6). Long-term hyperferritinemia due to intravenous iron therapy is a risk factor for death in maintenance hemodialysis patients. For a prolonged better prognosis, intravenous iron should be carefully administered so as to avoid hyperferritinemia in patients with hemodialysis.
Highlights
Iron supplementation with recombinant human erythropoietin is crucial in improving renal anemia in patients undergoing hemodialysis
E reported levels of serum ferritin, a representative marker of iron stores, in hemodialysis patients, are very different between Japan and Western countries. e amount of intravenous iron administered is higher in Western countries than that in Japan; the levels of serum ferritin are significantly higher in hemodialysis patients in Western countries than those in Japan [4, 7]
We report the long-term prognosis of patients with iatrogenic hyperferritinemia and discuss the controversies regarding the safety of intravenous iron therapy in patients undergoing maintenance hemodialysis
Summary
Iron supplementation with recombinant human erythropoietin (rHuEPO) is crucial in improving renal anemia in patients undergoing hemodialysis. An increasing number of studies report that iron overload in hemodialysis patients might promote atherosclerotic plaque instability; increase the risk of ischemic cardiovascular complications, immune dysfunction, and infection; and trigger nonalcoholic fatty liver disease [3–5]. The recently published PIVOTAL study confirmed the efficacy and safety of intravenous iron for the treatment of anemia in hemodialysis patients [4, 6]. E reported levels of serum ferritin, a representative marker of iron stores, in hemodialysis patients, are very different between Japan and Western countries. E amount of intravenous iron administered is higher in Western countries than that in Japan; the levels of serum ferritin are significantly higher in hemodialysis patients in Western countries than those in Japan [4, 7]. In a 2011 study from the USA, the median ferritin level in hemodialysis patients was International Journal of Nephrology
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