Effects of High Iron Levels on Kidney Function

Pathophysiological Mechanisms of Iron-Induced Kidney Injury

Excess iron disrupts cellular homeostasis by intensifying oxidative stress and inflammation, leading to disruption of iron-regulating hormones that can accelerate kidney damage 2, 3

In dialysis patients, iron overload can silently increase the burden of complications rather than inducing a full clinical picture, acting as a predictor of iron-mediated oxidative stress and inflammation 1, 4
High ferritin levels (consistently above 100 µg/L) in hemodialysis patients are associated with increased risk of acute cardiocerebrovascular disease (HR: 2.22), infections (HR: 1.76), and death (HR: 2.28) 5, 6

Dialysis patients with functional iron deficiency are more prone to iatrogenic iron overload than those with true iron deficiency 1
Diabetic dialysis patients (approximately 40% of all dialysis patients) may have a higher risk of complications from iron overload, as even slight increases in iron stores can worsen macrovascular and microvascular complications 7, 8
Patients with pre-existing liver diseases (viral hepatitis B and C, non-alcoholic steatohepatitis) may experience worsening of their condition with iron accumulation 5
Young dialysis patients with repeated graft failure and long cumulative dialysis vintage are at particular risk for long-term exposure to excessive iron 3

High-dose IV iron (>200 mg/month) in hemodialysis patients is associated with increased risk of acute cardiocerebrovascular disease (HR: 6.02), hospitalization (HR: 2.77), and infections (HR: 5.22) 2, 6
Monitoring ferritin levels is crucial, as a category switch from low to high ferritin is associated with increased risk of acute cardiocerebrovascular disease (HR: 1.59) and death (HR: 6.18) 2
In cases of severe iron overload, chelation therapy with deferasirox may be considered, though it should be used cautiously in patients with kidney impairment 10

Limiting IV iron doses to less than 136 mg/month may reduce mortality and cardiovascular events in hemodialysis patients 2
Maintenance iron therapy at 200 mg/month is not associated with increased short-term risk of infections, unlike bolus monthly doses of 700 mg 6