Introduction:
Iron overload is a significant and often overlooked complication in patients with end-stage renal disease (ESRD), particularly those undergoing hemodialysis (HD) or peritoneal dialysis (PD). The iatrogenic administration of intravenous (IV) iron to correct anemia, a common condition in ESRD, can lead to excessive iron accumulation in vital organs, especially the liver and heart. This abstract summarizes the current understanding of iron overload in ESRD patients, focusing on its prevalence, diagnosis, and implications for patient management.
Methods:
A systematic review and meta-analysis were conducted to assess the prevalence and severity of hepatic and cardiac iron overload in ESRD patients. Databases, including MEDLINE and Embase, were searched for studies reporting iron overload quantified by magnetic resonance imaging (MRI), the gold standard for non-invasive iron quantification. Studies involving adult ESRD patients undergoing HD, PD, or those who had undergone kidney transplantation were included. The Newcastle-Ottawa scale was employed to evaluate the methodological quality of the studies. Random-effects meta-analyses were performed to estimate the pooled prevalence of iron overload.
Results:
The meta-analysis included seven studies with 339 ESRD patients. The pooled prevalence of severe hepatic iron overload was 23% (95% CI: 8–43%), while mild to moderate hepatic iron overload was present in 52% (95% CI: 47–57%) of the patients. Notably, only three studies assessed cardiac iron overload, with none reporting significant iron accumulation in the heart. The findings underscore the high prevalence of hepatic iron overload in ESRD patients on HD, whereas cardiac iron overload appears less common or underreported.
Conclusions:
Hepatic iron overload is prevalent among ESRD patients, particularly those receiving HD. The accumulation of iron in the liver poses significant risks, including the potential for liver damage and exacerbation of comorbid conditions such as cardiovascular disease and diabetes mellitus. Despite the known risks, there is a lack of standardized guidelines for monitoring and managing iron overload in ESRD patients. T2* MRI remains the preferred modality for detecting and quantifying iron overload in the liver, but its use in routine clinical practice is limited by cost and accessibility. Further research is needed to establish evidence-based guidelines for managing iron overload in ESRD, including the role of iron chelation therapy and the potential benefits of newer treatments, such as hypoxia-inducible factor (HIF) stabilizers. Additionally, the relationship between hepatic iron overload and clinical outcomes in ESRD warrants further investigation.
I have no potential conflict of interest to disclose.
I used generative AI and AI-assisted technologies in the writing process.
During the preparation of this work, the authors used ChatGPT to assist with refining the abstract for clarity and structure. After using this tool, the authors reviewed and edited the content as needed and took (s) full responsibility for the publication's content.