Liver Iron Content by MRI at the start of hemodialysis

Introduction: Hepatic iron overload assessed by magnetic resonance imaging (MRI) has been described in the majority of chronic hemodialysis patients treated with intravenous (IV) iron, raising safety concerns. Whether iron overload is present in Chronic Kidney Disease (CKD) at the time of dialysis initiation is, however, unknown.

Methods: A prospective, observational, hospital-based study included 23 consecutive adult patients starting maintenance hemodialysis. Signal-intensityratio MRI was performed to calculate liver iron content (LIC). The association with clinical, biochemical markers of iron metabolism and prior anemia therapy was explored. MRI was repeated after 12 months in a cohort of 7 patients to explore LIC changes with time in hemodialysis under current anemia treatment.

Findings : At the start of hemodialysis, only 6 (26%) patients had normal LIC (<40 µmol/g), 14(61%)showedmild(40-100µmol/g) and3(13%)patientshadmoderate overload (101-200 µmol/g). None had severe overload. After 12 monthsin chronic hemodialysis underIV iron, LIC increased significantly,reachingmoderate overload in 6 patients and severe in one. Clinical, biochemical parameters and IV iron dose were not associated with the hepatic iron load detected in both occasions.

Conclusion: The results indicate that the majority of CKD patients have liver iron overload before initiating maintenance hemodialysis and that LIC increases steeply during the first year in dialysis with current anemia treatment.The observed major disturbance of iron homeostasis in CKD should be taken into account in newer approaches to anemia management in these patients.

Author(s): Patricia Carrilho,  Ines Santiago,  Marta Alves,  Pedro Fidalgo,  Elsa Rodrigues,  Pedro Campos and Bruno Rodrigues

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