Diagnosis and Management of Hepatic, Endocrine, and Cardiac Complications of Iatrogenic Iron Overload in Renal Patients

Background: Renal disease is associated with ineffective erythropoiesis. In such patient populations, reports on the extent, complications, and management of iatrogenic iron overload (IO), following repeated blood transfusions and intravenous iron supplementation, are rare. Patients and Methods: Over the past 5 years, 3572 patients on different modalities of renal therapies, viz. conservative, maintenance hemodialysis, maintenance peritoneal dialysis, and kidney transplantation, were screened for IO and its subsequent liver, endocrine, and heart complications. Diagnosis of IO was established by high transferrin saturation %, serum ferritin, bone marrow stores, and CT density. Liver disease was suspected with abnormal liver tests and abdominopelvic sonography. After exclusion of other causes of liver diseases, a liver biopsy was done to assess for IO-hepatopathy. In those patients, basal and dynamic hormonal tests as well as echocardiography were used to assess for IO-endocrinopathy and IO-cardiopathy. Results: A total of 823 (23%) had IO, of whom 23 patients with severe and long-standing exposure had IO-hepatopathy (6 with severe hemosiderosis and 17 with cirrhosis). In those patients, 2 had pituitary disease and 2 had dilated cardiomyopathy. Weekly phlebotomy for 1 month followed by twice monthly phlebotomy normalized their iron balance by 3 months in all patients with IO and halted the liver, endocrine, and heart complications, in the affected ones, by 42 ± 11 months of follow-up. Conclusion: IO-hepatopathy, endocrinopathy, and cardiomyopathy can develop following inappropriate and excessive intravenous iron infusions in renal patients on different RRT. Vigilant monitoring of their hematinic therapy is indicated and therapeutic phlebotomy is useful in its management.