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Nephrol Dial Transplant (2002) 17: 962-965
© 2002 European Renal Association-European Dialysis and Transplant Association

Editorial Comments

High dose intravenous iron: a note of caution

Josef Kletzmayr, Gere Sunder-Plassmann and Walter H. Hörl

Division of Nephrology, Department of Medicine III, University of Vienna, Vienna, Austria

Keywords: chronic kidney disease; high dose intravenous iron; toxicity

Introduction

The majority of patients with chronic kidney disease are anaemic. Iron deficiency should be corrected before treatment with recombinant human erythropoietin (rhuEpo) or novel erythropoiesis stimulating protein (NESP) is initiated. During maintenance rhuEpo or NESP therapy, iron supplementation is needed to prevent hyporesponsiveness to these drugs. On the other hand, iron supplementation is not without side-effects, particularly if high dose intravenous (i.v.) iron is administered.

Effects of iron overload on the cardiovascular system

Animal studies
In vivo studies showed that iron overload may result in cardiomyopathy, manifested by ventricular arrhythmias and heart failure [1]. Alterations of glutathione peroxidase activity and increases in cytotoxic aldehyde concentrations in the heart may contribute to iron-induced heart failure [1]. Extracellular hydroxyl radical formation is not responsible for iron-mediated cardiotoxicity [2]. This does not, however, exclude that myocardial iron toxicity is the result of free radical damage generated intracellularly. Experimental data demonstrate that vitamin E ({alpha}-tocopherol) completely inhibits . . . [Full Text of this Article]

Iron status and cardiovascular disease in man
Effect of iron depletion on cardiovascular disease

Genetic disease association studies

Ferritin levels and cardiovascular disease in end-stage renal disease

Effect of vitamin E on iron-induced changes

Acute adverse events of high-dose intravenous iron

Iron overload and disturbed host defence

Conclusion

Notes

References


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