Monday, July 23, 2012

Is Iron The answer?

As restrictions have arose in using of erythropoietin agents in dialysis patients, the use of IV iron has risen in the nephrology community. What are the rates of iron overload in such instances?
Studies have shown that excessive use of iron can intensify the oxidative stress associated with chronic kidney disease, and promote endothelial dysfunction and cardiac disease. Excessive iron reduces iron utilization and is involved in the generation of intracellular reactive oxygen species, which induce cell injury; the risk of subtle toxicity from iron excess exists. Unnecessary iron supplementation accelerates hepcidin  production. This effect on ferroportin 1 (FP-1), keeps intracellular iron from being carried even if the iron storage is adequate; it also decreases iron absorption from the intestine.In the most recent issue of the Am J of Medicine, an editorial to a  study done prospectively found that there was iron overload in 84% of a 119 stable HD patients. Some of the amount of iron reached the levels found in hemochromotosis. A prior study had shown that the risk factors were ferritin >500.   The Japanese Society for Dialysis Therapy Guidelines has proposed that a minimal amount of iron should be given to chronic kidney disease patients. Japanese clinicians believe that the risk/benefit ratio for iron supplementation is higher than that accepted in Western countries. So now what?
A proper attention to body's individual iron stores and ferritin levels along with perhaps hepcidin information might be a more prudent way to decide iron treatment. More robust guidelines might be needed.

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