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Pattern and clinical correlates of renal iron deposition in adult beta-thalassemia major patients

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Abstract

We evaluated pattern and clinical correlates of renal T2* measurements in adult β-thalassemia major (β-TM) patients. Ninety β-TM patients (48 females, 38.15 ± 7.94 years), consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia network, underwent T2* magnetic resonance imaging (MRI) for quantification of iron overload (IO) in kidneys, liver, pancreas, and heart. Ten (11.1%) patients showed renal IO (T2* < 31 ms). Global kidney T2* values did not show a correlation with gender, age, splenectomy, regular transfusions or chelation starting age, pre-transfusion hemoglobin, and serum ferritin levels. Global kidney T2* values showed an inverse correlation with MRI liver iron concentration (LIC) values (R = − 0.349; p = 0.001) and a positive correlation with global pancreas T2* values (R = 0.212; p = 0.045). Frequency of renal IO was significantly higher in patients with cardiac IO than in patients without cardiac IO (50.0% vs. 6.3%; p = 0.001). A significant inverse association was detected between global kidneys T2* values and lactate dehydrogenase (LDH) (R = − 0.529; p < 0.0001). In multivariate regression analysis, MRI LIC and LDH were the strongest predictors of global kidney T2* values. A MRI LIC > 4.83 mg/g dw predicted the presence of renal IO (sensitivity = 90.0%; specificity = 61.2%). Global kidney T2* values were inversely correlated with uric acid (R = − 0.269; p = 0.025). In conclusion, in adult β-TM patients, renal iron deposition is not common and is linked to both hemolysis and total body iron overload.

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Acknowledgements

We would like to thank all the colleagues involved in the E-MIOT project (https://emiot.ftgm.it/) and all patients for their cooperation. This work is generated within the European Reference Network on Rare Hematological Diseases (ERN-EuroBloodNet).

Funding

The E-MIOT project received “no-profit support” from industrial sponsorships (Chiesi Farmaceutici S.p.A. and Bayer). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1, 56124, Pisa, Italy

    Antonella Meloni, Vincenzo Positano, Laura Pistoia & Filippo Cademartiri

  2. U.O.C. Bioingegneria, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy

    Antonella Meloni & Vincenzo Positano

  3. U.O.C. Radiologia Generale E Di Pronto Soccorso, Azienda Ospedaliera Di Rilievo Nazionale “A. Cardarelli”, Naples, Italy

    Luigi Barbuto & Luigia Romano

  4. U.O.S.V.D. Ricerca Clinica, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy

    Laura Pistoia

  5. U.O.S.D. Malattie Rare del Globulo Rosso, Azienda Ospedaliera di Rilievo Nazionale “A. Cardarelli”, Naples, Italy

    Anna Spasiano

  6. S.O.C. Oncologia, Ematologia e Trapianto di Cellule Staminali Emopoietiche, Meyer Children’s Hospital IRCCS, Florence, Italy

    Tommaso Casini

  7. U.O. Oncoematologia Pediatrica, Azienda Ospedaliero Universitaria Pisana – Stabilimento S. Chiara, Pisa, Italy

    Francesco Massei

  8. Centro Di Talasssemia, Ospedale “San Giovanni Di Dio”, Agrigento, Italy

    Crocetta Argento

  9. Servizio Di Immunoematologia E Medicina Trasfusionale, Ospedale S. M. Goretti, Latina, Italy

    Piera Giovangrossi

  10. Unità Operativa di Pediatria e Oncoematologia - Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy

    Angelica Barone

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  1. Antonella Meloni
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Contributions

AM conceived the study, analyzed the data, interpreted the results, and wrote the paper. LB analyzed the renal T2* images. VP developed the software for image analysis. LP was responsible for data collection. AS, TC, FM, CA, PG, and AB collected the data. LR contributed to the interpretation of the results. FC supervised the study. All authors contributed to critical revision of the manuscript and read and approved the final version.

Corresponding author

Correspondence to Filippo Cademartiri.

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The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Ethics Committee of Area Vasta Nord Ovest (protocol code 56664, date of approval October 8, 2015).

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Informed consent was obtained from all patients included in the study.

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Meloni, A., Barbuto, L., Positano, V. et al. Pattern and clinical correlates of renal iron deposition in adult beta-thalassemia major patients. Clin Exp Med 23, 3573–3579 (2023). https://doi.org/10.1007/s10238-023-01133-x

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