Long-Term Prognosis of Hyperferritinemia Induced by Intravenous Iron Therapy in Patients Undergoing Maintenance Hemodialysis: A 10-Year, Single-Center Study

Abstract

Optimal ferritin level in hemodialysis patients between Japan and other countries is controversial. Long-term side effects of iron supplementation in these patients remain unclear. We aimed to elucidate whether past hyperferritinemia in hemodialysis patients was associated with high risk of death and cerebrovascular and cardiovascular diseases (CCVDs). This small retrospective cohort study included approximately 44 patients unintentionally supplemented with excessive intravenous iron. A significantly higher risk of CCVDs was observed in patients with initial serum ferritin levels ≥1000 ng/mL than in the remaining patients. High ferritin levels slowly decreased to <300 ng/mL in a median of 24.2 (10.5–46.5) months without treatment. However, compared with the remaining patients, only patients whose ferritin levels did not decrease to <300 ng/mL steadily had a significantly higher risk of all-cause death (hazard ratio, 9.6). Long-term hyperferritinemia due to intravenous iron therapy is a risk factor for death in maintenance hemodialysis patients. For a prolonged better prognosis, intravenous iron should be carefully administered so as to avoid hyperferritinemia in patients with hemodialysis.

High-dose versus low-dose iron sucrose in individuals undergoing maintenance haemodialysis: a retrospective study

“…Patients who experienced proactively administered high-dose intravenous iron were less likely to suffer nonfatal myocardial infarctions than those patients who underwent reactively administered low-dose intravenous iron. It is possible that a high-dose intravenous injection of iron in these cases with iron deficiency can reduce the risk of cardiovascular AEs [ 14 ]. Additionally, a high-dose intravenous iron regimen tends to decrease the incidence of hospitalization for heart failure.…”

“…Additionally, a high-dose intravenous iron regimen tends to decrease the incidence of hospitalization for heart failure. Although the intravenous iron regimen has been observed to result in a low rate of cardiovascular AEs in previous studies [ 9 , 14 ] involving patients with circulatory failure, to date, such a scenario has not been detected in patients undergoing maintenance haemodialysis. Additionally, patients who underwent a high-dose intravenous iron regimen failed to have more blood transfusions and higher doses of erythropoiesis-stimulating agents than those who underwent a low-dose intravenous iron regimen.…”

“…Patients with maintenance haemodialysis tend to suffer from negative iron balance, which is primarily attributed to reduced iron absorption and increased iron loss [ 14 , 15 ]. Intravenous iron sucrose has been considered as a standard processing scheme, as has been reported in prior studies [ 9 , 15 , 16 ].…”

“…Intravenous iron sucrose has been considered as a standard processing scheme, as has been reported in prior studies [ 9 , 15 , 16 ]. Increasing doses of iron sucrose can counteract exposure to erythropoiesis-stimulating agents, with the aim of decreasing the potential adverse events (AEs) that are associated with these agents, especially infection and cardiovascular events [ 9 , 14 , 17 , 18 ].…”

“…Moreover, the evidence-based assessment of the utilization of proactively administered high-dose iron sucrose in these patients is exceedingly limited [ 9 , 19 ]. Thus, there is a continuing debate about the benefits of proactively administered high-dose iron sucrose versus reactively administered low-dose iron sucrose [ 9 , 14 , 19 ]. Herein, we aimed to confirm whether patients undergoing maintenance haemodialysis who were treated with proactively administered high-dose iron sucrose had greater clinical benefits than those patients receiving reactively administered low-dose iron sucrose.…”