| Background:End-stage renal disease is often complicated with renal anemia.After the wide-spread use of ESA and IV iron from 1989,hemodialysis patients shifted from iron-deficiency to iron overload.This aroused great attention of clinicians.Iron overload in hemodialysis patients increases morbidity of infection and cardiovascular diseases.Kinds of lab indexes are used to assess iron overload so far:serum ferritin is easily affected by all kinds of inflammation;TSAT is not related to iron stores.Liver biopsy is the golden standard with high cost and potential risk.MRI assessing LIC is going to replace liver biopsy.Different studies using MRI have already monitored LIC of patients,but of crosse-section and relatively short retrospection time.Purpose:To assess iron overload in hemodialysis patients.MRI assessing LIC is used to supervise iron overload.To assess the correlation between LIC measured by MRI and culmulant of lab iron tests.Methods:(1)Retrospective study of iron use(IV iron and oral iron respectively),democratic indexes and lab tests in MHD patients.(2)Cross-section study of LIC assessed by MRI:Patients with elevated/low grade serum ferritin,elevated/low gradeⅣ iron sum are enrolled.Enrolled patients are categorized into LIC elevated group(T2*<11.4 ms)or LIC normal group(T2*≥11.4 ms).Software SPSS 19.0 is used for analysis.Results:1.Retrospective study:Ⅳ iron use proportion in MHD patients is increased from 2012 to 2015,and decreased from 2015 to 2018.Ⅳ iron summation per person is increased from 2012 to 2013,and decreased from 2013 to 2018.Oral iron summation and total iron summation per person is increased from 2012 to 2013,and decreased from 2013 to 2018.2.30 patients enrolled in cross-section study are categorized into 2 groups.LIC elevated group:age 51.53 ± 1.5;serum ferritin 431.1261 ±276.7475 μg/L;serum ferritin summation by time 2341.5275± 1522.8196 μg/L*y;TSAT 32.7350±8.8877%;HGB 109.9247 ± 6.9417 g/L;Ⅳ iron summation 7832.00 ± 5582.06 mg;Oral iron summation 45092.80 ±89960.92 mg.LIC normal group:age 55.60 ±14.46;serum ferritin 329.5736 ±190.6338 μg/L;serum ferritin summation by time 1724.8900 ±1189.8068 μg/L*y;TSAT 31.3101±15.9350%;HGB 114.1507±4.8778 g/L;IV iron summation 3806.66±4286.60 mg;Oral iron summation 94406.40± 106376.94 mg.3.There is no significant difference in total iron summation between the 2 groups,but significant in IV iron summation(p=0.035).Correlation analysis in IV iron summation between the 2 groups:coefficient of association is-0.436,P=0.016.Correlation analysis between LIC and spleen iron concentration:coefficient of association is 0.76,P=0.00.4.LIC as gold standard for assessing iron stores,ROC analysis results:no significance in serum iron,serum ferritin summation by time,cardiac iron concentration and pancreatic iron concentration.Area Under Curve of spleen iron concentration ROC is 0.838,standard error 0.074,P=0.02,CI(0.693,0.984).5.Coefficient of association between LIC and 2012～20118 IV iron summation is-0.436,P=0.016.Coefficient of association between LIC and 2012～2014 IV iron summation is-0.362,P=0.049.Coefficient of association between LIC and 2015～2018 IV iron summation is-0.485,P=0.007.6,6-year IV iron summation in LIC elevated group is 7832.00 ±5582.05mg;3-year 4293.33±2993.91 mg.6-year IV iron summation in LIC normal group is 3806.66±4386.60 mg;3-year 1993.33±2358.40 mg.6-year IV iron summation in LIC normal marginal group is 5888.83 ±4937.77 mg;3-year 966.66 ±2548.46 mg.Conclusion:1.With the publication of 2012 KDIGO guideline,clinicians emphasize the upper limit of iron use in MHD patients,and become more cautious with IV iron.2.LIC reflects IV iron summation.IV iron summation shows iron stores,while serum ferritin level does not.Spleen iron concentration can also reflect iron stores,and can be used with LIC.3.Recent IV iron is more related to iron stores compared with afar.4.After analysis of 6/3-year IV iron summation in LIC elevated/normal/normal marginal groups,we recommend mean IV iron summation per year below 763mg. |
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