Post-mortem liver and bone marrow iron quantification in haemodialysis patients: A prospective cohort study
Summary: Background: Magnetic resonance liver scans indicate that iron overload is common in haemodialysis (HD) patients. However, histological evidence is scarce. Methods: Liver biopsy and bone marrow aspirate were obtained in the first 24h post mortem from 21 adult HD patients. Biochemical liver...
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| Format: | Article |
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Elsevier
2022-03-01
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| Series: | EBioMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352396422001050 |
| _version_ | 1818138345140649984 |
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| author | Patricia Carrilho Pedro Fidalgo Anna Lima Lourdes Bastos Elisa Soares Rita Manso Alexandra Santos Lucinda Nobrega |
| author_facet | Patricia Carrilho Pedro Fidalgo Anna Lima Lourdes Bastos Elisa Soares Rita Manso Alexandra Santos Lucinda Nobrega |
| author_sort | Patricia Carrilho |
| collection | DOAJ |
| description | Summary: Background: Magnetic resonance liver scans indicate that iron overload is common in haemodialysis (HD) patients. However, histological evidence is scarce. Methods: Liver biopsy and bone marrow aspirate were obtained in the first 24h post mortem from 21 adult HD patients. Biochemical liver iron content (LIC) was quantified by electrothermal atomization atomic absorption spectrophotometry. Tissue iron deposition was graded in the liver and bone marrow using Scheuer and Gale's criteria, respectively. Findings: Median LIC was 42.5 (22.9-69.7) μmol/g and the majority (n=11; 57%) had mild to moderate liver iron overload (LIC >36 μmol/g). Scheuer grade was 2 (1-3) and 13 (62%) of liver biopsies had increased (> 1) iron deposition. In the bone marrow, median Gale's grade was 3 (3-4) and 9 (45%) patients had increased (>3) iron content.Contrary to old autopsy studies, done in the pre-erythropoiesis-stimulating agents (ESAs) era, both liver and bone marrow were iron replete and showed a positive correlation (r=0.71, p<0.001).Ferritin proved to have a good diagnostic accuracy for liver iron overload (0.87 95% CI 0.71-1.00) with an optimal cut-off value of 422 ng/ml. Haemoglobin was negatively associated with both LIC (r= -0.46, p=0.04) and iron content in the bone marrow (p=0.04). Patients with increased LIC had higher resistance to ESAs (p=0.02), yet no association with previous IV iron therapy. Interpretation: In the majority of HD patients there was iron accumulation in both the liver and bone marrow that associated with anaemia severity and resistance to ESAs, suggesting a blocking mechanism of iron's utilization. Funding: None. |
| first_indexed | 2024-12-11T10:10:43Z |
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| institution | Directory Open Access Journal |
| issn | 2352-3964 |
| language | English |
| last_indexed | 2024-12-11T10:10:43Z |
| publishDate | 2022-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EBioMedicine |
| spelling | doaj.art-0b28c697cfb24b6790b30d818942f2d42022-12-22T01:11:45ZengElsevierEBioMedicine2352-39642022-03-0177103921Post-mortem liver and bone marrow iron quantification in haemodialysis patients: A prospective cohort studyPatricia Carrilho0Pedro Fidalgo1Anna Lima2Lourdes Bastos3Elisa Soares4Rita Manso5Alexandra Santos6Lucinda Nobrega7Serviço de Nefrologia, Hospital Prof. Doutor Fernando da Fonseca, IC19, 2720-276, Amadora, Portugal; Corresponding Author: Patricia S. Carrilho, M.D., Hospital Professor Doutor Fernando Fonseca EPE, Amadora, PORTUGAL.Serviço de Nefrologia, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal; Unidade de Cuidados Intensivos Polivalente, Centro Hospitalar Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005. Lisboa, PortugalServiço de Nefrologia, Hospital Prof. Doutor Fernando da Fonseca, IC19, 2720-276, Amadora, PortugalFaculdade de Farmácia Universidade do Porto, Rua Aníbal Cunha, 164, 4050-047, Porto, PortugalFaculdade de Farmácia Universidade do Porto, Rua Aníbal Cunha, 164, 4050-047, Porto, PortugalServiço de Anatomia Patológica, Hospital Prof. Fernando da Fonseca, IC19, 2720-276, Amadora, PortugalServiço de Patologia Clínica, Hospital Prof. Fernando da Fonseca, IC19, 2720-276, Amadora, PortugalServiço de Patologia Clínica, Hospital Prof. Fernando da Fonseca, IC19, 2720-276, Amadora, PortugalSummary: Background: Magnetic resonance liver scans indicate that iron overload is common in haemodialysis (HD) patients. However, histological evidence is scarce. Methods: Liver biopsy and bone marrow aspirate were obtained in the first 24h post mortem from 21 adult HD patients. Biochemical liver iron content (LIC) was quantified by electrothermal atomization atomic absorption spectrophotometry. Tissue iron deposition was graded in the liver and bone marrow using Scheuer and Gale's criteria, respectively. Findings: Median LIC was 42.5 (22.9-69.7) μmol/g and the majority (n=11; 57%) had mild to moderate liver iron overload (LIC >36 μmol/g). Scheuer grade was 2 (1-3) and 13 (62%) of liver biopsies had increased (> 1) iron deposition. In the bone marrow, median Gale's grade was 3 (3-4) and 9 (45%) patients had increased (>3) iron content.Contrary to old autopsy studies, done in the pre-erythropoiesis-stimulating agents (ESAs) era, both liver and bone marrow were iron replete and showed a positive correlation (r=0.71, p<0.001).Ferritin proved to have a good diagnostic accuracy for liver iron overload (0.87 95% CI 0.71-1.00) with an optimal cut-off value of 422 ng/ml. Haemoglobin was negatively associated with both LIC (r= -0.46, p=0.04) and iron content in the bone marrow (p=0.04). Patients with increased LIC had higher resistance to ESAs (p=0.02), yet no association with previous IV iron therapy. Interpretation: In the majority of HD patients there was iron accumulation in both the liver and bone marrow that associated with anaemia severity and resistance to ESAs, suggesting a blocking mechanism of iron's utilization. Funding: None.http://www.sciencedirect.com/science/article/pii/S2352396422001050AnaemiaChronic kidney diseaseHaemodialysisLiver iron contentElectrothermal atomization atomic absorption spectrophotometryBone marrow |
| spellingShingle | Patricia Carrilho Pedro Fidalgo Anna Lima Lourdes Bastos Elisa Soares Rita Manso Alexandra Santos Lucinda Nobrega Post-mortem liver and bone marrow iron quantification in haemodialysis patients: A prospective cohort study EBioMedicine Anaemia Chronic kidney disease Haemodialysis Liver iron content Electrothermal atomization atomic absorption spectrophotometry Bone marrow |
| title | Post-mortem liver and bone marrow iron quantification in haemodialysis patients: A prospective cohort study |
| title_full | Post-mortem liver and bone marrow iron quantification in haemodialysis patients: A prospective cohort study |
| title_fullStr | Post-mortem liver and bone marrow iron quantification in haemodialysis patients: A prospective cohort study |
| title_full_unstemmed | Post-mortem liver and bone marrow iron quantification in haemodialysis patients: A prospective cohort study |
| title_short | Post-mortem liver and bone marrow iron quantification in haemodialysis patients: A prospective cohort study |
| title_sort | post mortem liver and bone marrow iron quantification in haemodialysis patients a prospective cohort study |
| topic | Anaemia Chronic kidney disease Haemodialysis Liver iron content Electrothermal atomization atomic absorption spectrophotometry Bone marrow |
| url | http://www.sciencedirect.com/science/article/pii/S2352396422001050 |
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