Liver Iron Content by MRI at the start of hemodialysis


Liver Iron Content by MRI at the start of hemodialysis

Journal of Nephrology and Urology is an Open Access peer-reviewed publication that discusses current research and advancements in diagnosis and management of kidney disorders as well as related epidemiology, pathophysiology and molecular genetics.

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Intravenous iron therapy is increasingly used as part of the treatment of anemia in chronic kidney disease (CKD) and hemodialysis patients . Recent Magnetic Resonance Imaging (MRI) studies have shown that most maintenance hemodialysis patients receiving intravenous (IV) iron supplementation have moderate to severe hepatic iron overload, considered a reason for concern. It is unclear, however, how that hepatic overload develops, whether it is already present before iron therapy or hemodialysis start and why in the majority of patients undergoing hemodialysis, iron seems to be directly destined to the deposits with significant changes in ferritin levels, but without comparable changes in hemoglobin or transferrin saturation 

This study aims to contribute to clarifying those questions by analysing liver iron content (LIC) by MRI in a sample of patients at the start of maintenance hemodialysis, repeating LIC measurement 12 months later and exploring the determinants of iron overload.

Clinical data were collected, including demographic characteristics and history of previous transfusion, iron and erythropoesis stimulating agents (ESA) therapy in the last 36 months. Charlson comorbidity index (CCI) and body mass index (BMI) were calculated. In order to quantify alcohol consumption and identify active alcohol use disorders, patients were asked to complete confidentially AUDIT-C questionnaire

Scans were reviewed in consensus by two dedicated radiologists, who were blinded for clinical data. Oval regions of interest were placed in 3 lobe liver regions and right and left paraspinous muscles, each with a minimum area of 50 mm2. Mean signal intensity values were inserted in the University of Rennes’ online worksheet to calculate LIC based on the Gandon’s algorithm. The upper limit of normal was set at 40 μmol/g. Values between 40 and 100 μmol/g were considered to represent mild iron overload, values between 101 and 200 μmol/g moderate iron overload; and values >200 μmol/g severe iron overload.

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Journal of Nephrology and Urology