Cargando…
Risk of iron overload with chronic indiscriminate use of intravenous iron products in ESRD and IBD populations
The routine use of recombinant erythropoiesis-stimulating agents (ESA) over the past three decades has enabled the partial correction of anaemia in most patients with end-stage renal disease (ESRD). Since ESA use frequently leads to iron deficiency, almost all ESA-treated haemodialysis patients worl...
Autores principales: | , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6627982/ https://www.ncbi.nlm.nih.gov/pubmed/31338466 http://dx.doi.org/10.1016/j.heliyon.2019.e02045 |
_version_ | 1783434860549898240 |
---|---|
author | Rostoker, Guy Vaziri, Nosratola D. |
author_facet | Rostoker, Guy Vaziri, Nosratola D. |
author_sort | Rostoker, Guy |
collection | PubMed |
description | The routine use of recombinant erythropoiesis-stimulating agents (ESA) over the past three decades has enabled the partial correction of anaemia in most patients with end-stage renal disease (ESRD). Since ESA use frequently leads to iron deficiency, almost all ESA-treated haemodialysis patients worldwide receive intravenous iron (IV) to ensure sufficient available iron during ESA therapy. Patients with inflammatory bowel disease (IBD) are also often treated with IV iron preparations, as anaemia is common in IBD. Over the past few years, liver magnetic resonance imaging (MRI) has become the gold standard method for non-invasive diagnosis and follow-up of iron overload diseases. Studies using MRI to quantify liver iron concentration in ESRD have shown a link between high infused iron dose and risk of haemosiderosis in dialysis patients. In September 2017, the Pharmacovigilance Committee (PRAC) of the European Medicines Agency (EMA) considered convergent publications over the last few years on iatrogenic haemosiderosis in dialysis patients and requested that companies holding marketing authorization for iron products should investigate the risk of iron overload, particularly in patients with end-stage renal disease on dialysis and, by analogy, patients with IBD. We present a narrative review of data supporting the views and decision of the EMA, and then give our expert opinion on this controversial field of anaemia therapeutics. |
format | Online Article Text |
id | pubmed-6627982 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-66279822019-07-23 Risk of iron overload with chronic indiscriminate use of intravenous iron products in ESRD and IBD populations Rostoker, Guy Vaziri, Nosratola D. Heliyon Article The routine use of recombinant erythropoiesis-stimulating agents (ESA) over the past three decades has enabled the partial correction of anaemia in most patients with end-stage renal disease (ESRD). Since ESA use frequently leads to iron deficiency, almost all ESA-treated haemodialysis patients worldwide receive intravenous iron (IV) to ensure sufficient available iron during ESA therapy. Patients with inflammatory bowel disease (IBD) are also often treated with IV iron preparations, as anaemia is common in IBD. Over the past few years, liver magnetic resonance imaging (MRI) has become the gold standard method for non-invasive diagnosis and follow-up of iron overload diseases. Studies using MRI to quantify liver iron concentration in ESRD have shown a link between high infused iron dose and risk of haemosiderosis in dialysis patients. In September 2017, the Pharmacovigilance Committee (PRAC) of the European Medicines Agency (EMA) considered convergent publications over the last few years on iatrogenic haemosiderosis in dialysis patients and requested that companies holding marketing authorization for iron products should investigate the risk of iron overload, particularly in patients with end-stage renal disease on dialysis and, by analogy, patients with IBD. We present a narrative review of data supporting the views and decision of the EMA, and then give our expert opinion on this controversial field of anaemia therapeutics. Elsevier 2019-07-12 /pmc/articles/PMC6627982/ /pubmed/31338466 http://dx.doi.org/10.1016/j.heliyon.2019.e02045 Text en © 2019 Published by Elsevier Ltd. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Article Rostoker, Guy Vaziri, Nosratola D. Risk of iron overload with chronic indiscriminate use of intravenous iron products in ESRD and IBD populations |
title | Risk of iron overload with chronic indiscriminate use of intravenous iron products in ESRD and IBD populations |
title_full | Risk of iron overload with chronic indiscriminate use of intravenous iron products in ESRD and IBD populations |
title_fullStr | Risk of iron overload with chronic indiscriminate use of intravenous iron products in ESRD and IBD populations |
title_full_unstemmed | Risk of iron overload with chronic indiscriminate use of intravenous iron products in ESRD and IBD populations |
title_short | Risk of iron overload with chronic indiscriminate use of intravenous iron products in ESRD and IBD populations |
title_sort | risk of iron overload with chronic indiscriminate use of intravenous iron products in esrd and ibd populations |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6627982/ https://www.ncbi.nlm.nih.gov/pubmed/31338466 http://dx.doi.org/10.1016/j.heliyon.2019.e02045 |
work_keys_str_mv | AT rostokerguy riskofironoverloadwithchronicindiscriminateuseofintravenousironproductsinesrdandibdpopulations AT vazirinosratolad riskofironoverloadwithchronicindiscriminateuseofintravenousironproductsinesrdandibdpopulations |