Intravenous iron, inflammation, and ventricular dysfunction during hemodialysis.

Note: Values for continuous variables given as mean 6 standard deviation or median [interquartile range]; values for categorical variable, as number (percentage). The t test was used for normally distributed and Wilcoxon signed rank test for skewed parameters. The proportion of patients with IV iron dose . 300 mg/mo was tested with c test. Abbreviations: HD, hemodialysis; IV, intravenous; LV, left ventricular. Ferricarboxymaltose in 83 patients; iron(III)-hydroxide dextran complex in 14 patients. In the 13 patients who used epoetin beta, the weekly epoetin beta dose was divided by 200 to achieve darbepoetin equivalence. To the Editor: Assa et al describe an association between circulating inflammatory cytokine concentrations and hemodialysis-induced left ventricular (LV) systolic dysfunction. The authors speculate that inflammation could adversely affect endothelial or myocyte function in the heart. Intravenous (IV) iron preparations cause inflammation, endothelial dysfunction, and oxidative stress, as reviewed by Van Buren et al. However, Assa et al did not address the possible etiologic contribution of IV iron. The proportion of patients receiving IV iron has increased substantially over the past 15 years, as have iron doses. In an international analysis, we recently reported an association between higher doses of IV iron and mortality among hemodialysis patients. We encourage the authors to examine whether there is an association (or a trend) between high IV iron doses and intradialytic LV dysfunction. We suggest comparing patients who received doses $ 300 mg/mo versus ,300 mg/mo, based on our mortality findings. It also would be of interest to see whether serum ferritin concentration, a marker of iron burden, correlates with LV dysfunction after adjustment for the other inflammatory markers. However, it is possible that the sample size of only 29 patients with LV dysfunction will prove too small to permit inferences.