WHAT ARE THE BIOMARKER THRESHOLDS FOR CONSIDERING IRON OVERLOAD SCREENING WITH T2*-WEIGHTED MRI IN PATIENTS WITH CKD?

Certificate Output Instructions

For best output, select "Paper Size" as "A4" and "Margin" as "0" or "None".

To save or print to PDF, please select Print Destination > Save as PDF, enable Background Graphics under "More Settings", then click "Save".

Certificate Background

Presented the abstract " "
(Abstract co-author(s): )

Back

E-Poster Presentation

During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.

Preparing your E-Poster

Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.

E-Poster Submission Deadline

Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.

E-Poster Format Requirements

PDF file
Layout: Portrait (vertical orientation)
One page only (Dim A4: 210 x 297mm or PPT)
E-Poster can be prepared in PowerPoint (one (1) PowerPoint slide) but must be saved and submitted as PDF file.
File Size: Maximum file size is 2 Megabytes (2 MB)
No hyperlinks, animated images, animations, and slide transitions
Language: English
Include your abstract number
E-posters can include QR codes, tables and photos

E-Poster

Abstract Title *

WHAT ARE THE BIOMARKER THRESHOLDS FOR CONSIDERING IRON OVERLOAD SCREENING WITH T2*-WEIGHTED MRI IN PATIENTS WITH CKD?

Please follow the instructions below to input your abstract title.

Abstract titles should be brief and reflect the content of the abstract.

The title will not be accepted if it exceeds 25 words.
Type in CAPITAL LETTERS.
Lowercase may be used for abbreviations only, for example, mRNA.

Co-author 1

Abdulqadir J. Nashwan anashwan@hamad.qa Hamad Medical Corporation 1. Nursing & Midwifery Research Department Doha Qatar *

Co-author 2

Abdullah Hamad AHamad9@hamad.qa Hamad Medical Corporation Nephrology Department Doha Qatar -

Co-author 3

Hassan A. Al-Malki halmalki1@hamad.qa Hamad Medical Corporation Nephrology Department Doha Qatar -

Co-author 4

Maryam A. Al Kuwari malkuwari5@hamad.qa Hamad Medical Corporation Radiology & Molecular Imaging Department Doha Qatar -

Co-author 5

Ali Al-Radaideh ali.al-radaideh@udst.edu.qa University of Doha for Science & Technology Department of Medical Radiography, College of Health Sciences Doha Qatar -

Co-author 6

Mohamed A. Yassin yassin@hamad.qa Hamad Medical Corporation Department of Medical Oncology, Hematology and BMT Section, National Center for Cancer Care and Research Doha Qatar -

Co-author 7

-

Co-author 8

-

Co-author 9

-

Co-author 10

-

Co-author 11

-

Co-author 12

-

Co-author 13

-

Co-author 14

-

Co-author 15

-

Introduction

Anemia management in patients with chronic kidney disease (CKD) relies heavily on intravenous iron supplementation, particularly in patients on hemodialysis. However, excessive iron administration may lead to iron overload, a condition associated with hepatic, cardiac, and endocrine complications, as well as other complications. Clinical guidelines primarily use serum ferritin and transferrin saturation (TSAT) to assess iron status, yet these biomarkers lack specificity in the context of inflammation. This review critically evaluates existing thresholds for iron overload and advocates for the integration of T2*-weighted magnetic resonance imaging (MRI) as an adjunct screening tool.

Methods

A systematic search has been conducted to capture the international and institutional clinical guidelines for anemia management in patients with CKD, with a specific focus on thresholds used to define iron overload. Guidelines were identified through targeted searches of official websites and repositories of major nephrology societies and regulatory bodies, including Kidney Disease: Improving Global Outcomes (KDIGO), Kidney Disease Outcomes Quality Initiative (KDOQI), the National Institute for Health and Care Excellence (NICE), and the European Renal Best Practice (ERBP) group. Institutional protocols from selected tertiary care centers were also reviewed when publicly accessible.

Results

A total of 7 clinical guidelines plus 1 empirical study were extracted. Most clinical guidelines define iron overload conservatively, with ferritin thresholds ranging from >300 ng/mL (Japan) to >800 ng/mL (UK and HMC (Hamad Medical Corporation, Qatar)), and TSAT typically exceeding 50% (see Table 1). In contrast, MRI-based studies demonstrate that mild liver iron overload can occur at ferritin levels as low as 160 ng/mL, with severe overload observed at levels of 290 ng/mL or higher (Rostoker et al., 2015). These discrepancies suggest that iron overload may be under-recognized until advanced stages. T2*-weighted MRI provides a validated, non-invasive method for detecting organ-specific iron accumulation, which may support earlier intervention and improve outcomes.

Table 1. Comparison of Iron Overload Thresholds in CKD Across Clinical Guidelines and Evidence-Based Literature

Source / Guideline	Ferritin Threshold (ng/mL)	TSAT Threshold (%)	Action / Definition of Overload
KDIGO (2025 Draft) [1]	>700	≥45	Avoid IV iron if ferritin >700 or TSAT ≥45 unless strong indication
KDIGO (2012) [2]	>500	>30	Avoid IV iron if TSAT >30% and ferritin >500 without a clear indication
UK Kidney Association (2021) [3]	>800	>50	Hold iron; target ferritin 200–800 and TSAT 20–50
ERBP (2013) [4]	>500–800	>30–50	Cautious use; avoid iron overload; monitor closely
Japanese Society for Dialysis Therapy (2015) [5]	>300	>50	Conservative thresholds due to oxidative stress risk
Canadian Society of Nephrology (2013) [6]	>500	>30	Recommends caution and an individualized approach
HMC Guidelines (CPRO 22014, 2022) [7]	>800	>50	Defines iron overload; hold iron therapy and monitor monthly
Rostoker et al (2015) [8]	≥160 (predicts LIC >50 µmol/g), ≥290 (predicts LIC >200 µmol/g)	N/A	MRI-defined hepatic iron overload thresholds via LIC correlation
KDIGO (Kidney Disease: Improving Global Outcomes), IV (Intravenous), TSAT (Transferrin Saturation), UK (United Kingdom), ERBP (European Renal Best Practice), JSDT (Japanese Society for Dialysis Therapy), CSN (Canadian Society of Nephrology), HMC (Hamad Medical Corporation), CPRO (Clinical Practice Guideline Reference Order), MRI (Magnetic Resonance Imaging), LIC (Liver Iron Concentration)

Conclusion

There is a clear divergence between current clinical guidelines and imaging-based definitions of iron overload in CKD. Existing ferritin thresholds may delay the detection of tissue-level iron accumulation. Incorporating T2*-weighted MRI and lowering biomarker cutoffs in high-risk populations could facilitate earlier diagnosis and more tailored management. The comparative analysis in Table 1 underscores the urgent need for updated, evidence-aligned strategies to redefine iron overload in CKD care. However, lack of cost-effectiveness studies, limited availability, and the need for specialized expertise may hinder widespread implementation, particularly in resource-limited settings.

References

1. Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO Anemia in CKD Guideline: Public Review Draft. November 4, 2024. Available from: https://kdigo.org/wp-content/uploads/2024/11/KDIGO-2025-Anemia-in-CKD-Guideline_Public-Review-Draft_Nov42024.pdf

2. Kidney Disease: Improving Global Outcomes (KDIGO) Anemia Work Group. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney Int Suppl. 2012;2(4):279–335. PMID: 25018991.

3. Macdougall IC, Bircher AJ, Eckardt KU, Obrador GT, Pollock CA, Stenvinkel P, et al. Iron management in chronic kidney disease: conclusions from a "Kidney Disease: Improving Global Outcomes" (KDIGO) Controversies Conference. Clin Kidney J. 2021;14(3):700–719. PMID: 33867794.

4. Locatelli F, Bárány P, Covic A, De Francisco A, Del Vecchio L, Goldsmith D, et al. Kidney Disease: Improving Global Outcomes guidelines on anaemia management in chronic kidney disease: a European Renal Best Practice position statement. Nephrol Dial Transplant. 2013;28(6):1340–1349. PMID: 23625983.

5. Akizawa T, Nangaku M, Yamada T, Nishi S, Hirakata H, Watanabe Y, et al. Revised JSDT Guidelines for Renal Anemia in Chronic Kidney Disease. Clin Exp Nephrol. 2016;20(1):1–8. PMID: 26428238.

6. Manns B, Whitlock R, Hemmelgarn B, Donaldson C, Ali M, Tonelli M, et al. Commentary on the KDIGO Clinical Practice Guideline for Anemia in CKD: Canadian Society of Nephrology. Am J Kidney Dis. 2013;61(1):130–140. PMID: 23177835.

7. Hamad Medical Corporation. CPRO 22014: Anemia Management in Adult Dialysis Population. Doha, Qatar: HMC; 2022.

8. Rostoker G, Griuncelli M, Loridon C, Bruckert F, de Almeida MJ, Cohen Y. Reassessment of iron biomarkers for prediction of liver iron concentration determined by MRI in dialysis patients. PLoS One. 2015;10(11):e0132006. PMID: 26517593.

Kewords