Association of sepsis with iron overload in hemodialysis patients receiving intravenous iron therapy

Intravenous (IV) iron used to treat anemia of Chronic Kidney Disease (CKD) in Hemodialyzed (HD) patients, may lead to iron overload. The incidence of sepsis in CKD patients with iron overload was studied. Procalcitonin and pro-inflammatory cytokines were used as markers. Serum procalcitonin was estimated semi quantitatively and pro-inflammatory cytokines (IL-1β, IL-6, TNF-α) were quantified by ELISA. The study groups comprised of CKD patients on hemodialysis, receiving IV iron (n = 33) and CKD patients not on hemodialysis and receiving oral iron therapy (n = 36). Among patients receiving IV iron and on HD, non-survivors had significant (p<0.05) iron overload. 36.7% of HD patients had hyperferritinemia (>800 ng mL-1. Among them, those having PCT>10 ng mL ^-1, had a mortality of 67%. Elevated interleukin-6 and tumor necrosis factor-a were associated with higher rates of mortality. Iron overload is an additional risk factor propagating sepsis in hemodialyzed patients.