Evidence of pancreatic iron deposits and their association with mortality in dialysis-associated iatrogenic hemosiderosis

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ABSTRACT Background Iron overload by liver magnetic resonance imaging (MRI) is highly prevalent today in the hemodialysis population worldwide and is a controversial topic in the management of dialysis-related anemia, as iron deposits can be seen on MRI but without clinical consequences. The aim of this study was to look for evidence of pancreatic iron deposits (a surrogate marker of severity in iron overload diseases) and their possible association with mortality. Methods Liver iron concentration was analyzed in 115 patients on dialysis using signal intensity ratio MRI and R2* Relaxometry MRI to determine liver, spleen, spine and pancreas iron loads. Results Overall, 44.3% (51/115) had liver iron overload upon MRI and 20% (23/115) of patients exhibited increased pancreatic iron load. The percentage of patients with abnormal pancreatic T2* was significantly higher in the group with moderate and severe liver iron overload [46.7% (7/15)] as compared with the groups of patients with normal iron load [15.6% (10/64)] and mild iron overload [16.7% (6/36)] (P = .032, Fisher’s exact test). Median survival time was reduced to 2.6 years in patients with pancreatic iron deposits as compared with 6.6 years in patients with normal pancreatic iron (P = .028, Log-rank test). Pancreatic iron deposits were associated with a 3-fold higher risk of death in the Cox proportional hazard regression model (hazard ratio 3.614, P = .0031). Conclusion Pancreatic iron deposits are observed in a substantial proportion of patients on dialysis with moderate and severe liver iron overload and may be associated with an increased risk of mortality. Trial registration: ClinicalTrials.gov number NCT05593068.

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