Abstract
Iron stores become depleted in ESRD patients on hemodialysis due to a variety of reasons including hemolysis during dialysis and blood loss into the dialyzer and tubing. Iron deficiency is assessed by measuring serum ferritin, serum iron, and/or transferrin TSAT (transferrin saturation = total iron/TIBC × 100). Free iron is not detectable in vivo as long as transferrin is less than fully saturated. Serum ferritin is a labile marker affected by chronic infection and inflammation. Also, generally speaking, serum ferritin is a more useful gauge of iron status at lower values than at higher ones. A high serum ferritin level is associated with altered chemotactic and phagocytic properties of neutrophils, thereby reducing their ability to kill invading pathogens. However, unanswered is the question of whether serum ferritin levels are elevated due to increased iron stores or infection. Infection, per se, may elevate serum ferritin levels inducing neutrophil dysfuntion. When studies control for covariates, such as use of catheters and previous infections, the purported infectious risk associated with iron administration or elevated serum ferritin levels is reduced or eliminated.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Hoen B. Iron and infection: clinical experience. Am J Kidney Dis. 1999;34(Supplement 2):S30–S34.
Fishbane S. Review of issues relating to iron and infection. Am J Kidney Dis. 1999;34(Supplement 2):S47–S52.
Sunder-Plassmann G, Patruta SI, Horl WH. Pathobiology of the role of iron in infection. Am J Kidney Dis. 1999;34(Supplement 2):S25–S29.
Seifert A, von Herrath D, Schaefer K. Iron overload, but not treatment with desferrioxamine favours the development of septicemia in patients on maintenance hemodialysis. Q J Med. 1987;65(248):1015–1024.
Boelaert JR, Cantinieaux BF, Hariga CF, Fondu PG. Recombinant erythropoietin reverses polymorphonuclear granulocyte dysfunction in iron-overloaded dialysis patients. Nephrol Dial Transplantation. 1990;5:504–517.
Besarab A, Frinak S, Yee J. An indistinct balance: the safety and efficacy of parenteral iron therapy. J Am Soc Nephrol. 1999;10:2029–2043.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2002 Springer Science+Business Media New York
About this chapter
Cite this chapter
Haria, D.M. (2002). Myth: Intravenous iron may be hazardous in infected hemodialysis patients. In: Friedman, E.A., Anees, I. (eds) Myths and Shibboleths in Nephrology. Springer, Dordrecht. https://doi.org/10.1007/978-94-010-0407-7_10
Download citation
DOI: https://doi.org/10.1007/978-94-010-0407-7_10
Publisher Name: Springer, Dordrecht
Print ISBN: 978-1-4020-0616-6
Online ISBN: 978-94-010-0407-7
eBook Packages: Springer Book Archive