PDF(Pubmed)
Abstract：
Background/Objectives: Anemia is a frequent multifactorial co-morbidity in end-stage kidney disease (ESKD) associated with morbidity and poor QoL. Apart from insufficient erythropoietin formation, iron deficiency (ID) contributes to anemia development. Identifying patients in need of iron supplementation with current ID definitions is difficult since no good biomarker is available to detect actual iron needs. Therefore, new diagnostic tools to guide therapy are needed. Methods: We performed a prospective cohort study analyzing tissue iron content with MRI-based R2*-relaxometry in 20 anemic ESKD patients and linked it with iron biomarkers in comparison to 20 otherwise healthy individuals. Results: ESKD patients had significantly higher liver (90.1 s-1 vs. 36.1 s-1, p < 0.001) and spleen R2* values (119.8 s-1 vs. 19.3 s-1, p < 0.001) compared to otherwise healthy individuals, while their pancreas and heart R2* values did not significantly differ. Out of the 20 ESKD patients, 17 had elevated spleen and 12 had elevated liver R2* values. KDIGO guidelines (focusing on serum iron parameters) would recommend iron supplementation in seven patients with elevated spleen and four patients with elevated liver R2* values. Conclusions: These findings highlight that liver and especially spleen iron concentrations are significantly higher in ESKD patients compared to controls. Tissue iron overload diverged from classical iron parameters suggesting need of iron supplementation. Measurement of MRI-guided tissue iron distribution might help guide treatment of anemic ESKD patients.
摘要：
背景/目标：贫血是终末期肾病（ESKD）中常见的多因素合并症，与发病率和QoL差相关。除了促红细胞生成素形成不足，缺铁（ID）有助于贫血的发展。用当前的ID定义来鉴定需要补充铁的患者是困难的,因为没有良好的生物标志物可用于检测实际的铁需求。因此,需要新的诊断工具来指导治疗。方法：我们进行了一项前瞻性队列研究，分析了20例贫血性ESKD患者的基于MRI的R2*弛豫测定法的组织铁含量，并与20例其他健康个体进行了比较。结果：ESKD患者的肝脏明显升高（90.1s-1vs.36.1s-1，p<0.001）和脾脏R2*值（119.8s-1vs.19.3s-1，p<0.001)与其他健康个体相比，而它们的胰腺和心脏R2*值没有显着差异。在20名ESKD患者中，17具有升高的脾脏和12具有升高的肝脏R2*值。KDIGO指南（侧重于血清铁参数）建议在7例脾脏升高的患者和4例肝脏R2*值升高的患者中补充铁。结论：这些发现突出表明，与对照组相比，ESKD患者的肝脏尤其是脾脏铁浓度明显更高。组织铁过载与经典的铁参数不同，表明需要补充铁。MRI引导的组织铁分布测量可能有助于指导贫血ESKD患者的治疗。
