Frequency of Iatrogenic Iron Overload in Hemodialysis Patients at Qena University Hospital

Abstract

Background:Iron overload (IO) appears in cases with end-stage renal disease (ESRD) treated with erythropoiesis-stimulating agents (ESA) & parenteral iron, with liver iron storage concentrations closely related to total body iron stores. Objectives:To estimate the frequency of iatrogenic iron overload among end-stage chronic kidney disease patients undergoing regular HD and to ascertain the primary determinants of risk & complications associated with iatrogenic iron overload in hemodialysis cases at Qena University Hospital. Patients and Methods: This was a cross-sectional study involving 96 adult ESRD subjects undergoing maintenance dialysis for at least three months at the nephrology unit of Qena University Hospital, from 1/12/2022 to 1/6/2023. All patients were submitted to full history taking, Full clinical examination, Estimation of body mass index, Laboratory investigation including CBC, Iron profile, Kidney function test, glomerular filtration rate, Liver function, C-reactive protein, liver fibrosis indices, inflammatory indices and liver ultrasonography. Results:58.3percentmen& 41.7 percentwomen were included;the mean age was 53.32 ± 13.60 years, and 66.7% had less than 5 years of dialysis duration. The common causes of their CKD were hypertension (41.7%), idiopathic (28.1%), and diabetes (18.8%). They have a mean serum ferritin level of 721.96 ± 626.72 ng/ml, which was correlated with the patient’s age and dialysis duration. 60 patients (63.22%) utilized blood transfusion; 46 (47.9%) received parenteral iron; and 42 (43.8%) got ESA. 47.22%of patients had hyperferritinemia, and 29.16% had IO. Liver ultrasonography revealed diffuse hepatic pathology (21.9%), mild hepatomegaly (6.3%),and 2.1% had a fatty liver.Out of 22 patients with normal ferritin levels, 4 have diffuse hepatic pathology (18.18%), 3 have diffuse hepatic pathology with mild hepatomegaly (13.64%), and 1 hasa bright liver (4.55%). Of 46 hyperferritinemia patients, 5 have diffuse hepatic pathology (10.87%), 2 have diffuse hepatic pathology with mild hepatomegaly (4.35%), and 5 have a bright liver (10.87%). Of 28 IO patients, 11 have diffuse hepatic pathology (39.29%), 1 has diffuse hepatic pathology with mild hepatomegaly (3.57%), 1 has liver cysts (3.57%), and 2 have fatty liver (7.14%). Patients with IO have significant heart symptoms. Conclusion:Out of 96 ESRD patients, 29.16% had IO, and 47.92% had hyperferritinemia associated with the presence of hepatic pathology. It is necessary to monitor blood or organ siderosis, use parenteral iron cautiously, and find a safe cut-off value for ferritin.

Keywords

• iron overload iatrogenic
• hemodialysis