Iron Overload in Dialysis Patients: Rust or Bust?

A recent study using magnetic resonance imaging (MRI) to assess liver iron content (LIC) by Issad and colleagues provides observational data from prevalent peritoneal dialysis patients, showing that few have iron overload. These results complement earlier MRI studies in hemodialysis patients by Rostoker et al. and other groups showing high MRIestimated LIC in hemodialysis patients and a high incidence of moderate to severe iron overload. The discussions in these reports, and in several editorials and commentaries, have warned that our present i.v. iron use practices are overloading hemodialysis patients and carry great risk. Anemia is a major problem in most patients receiving chronic dialysis, and treatment with i.v. iron was necessary in some even before the approval of epoetin in 1989. Fewer than 10% of patients in this era were transfusion dependent, but over the years these patients developed iron overload. In 1 study of 12 such patients, ferritin ranged from 3000 to 19,360 mg/l, transferrin