The etiological relation between serum iron level and infection incidence in hemodialysis uremic patients [Etiološi odnos serumske razine željeza i incidencije infekcije u bolesnika liječenih kroničnom hemodijalizom]

Galić, Gordan and Tomić, Monika and Galešić, Krešimir and Kvesić, Ante and Šoljić, Martina and Lončar, Zdravka and Valenčić, Maksim and Martinović, Željko and Vučkov, Šime (2011) The etiological relation between serum iron level and infection incidence in hemodialysis uremic patients [Etiološi odnos serumske razine željeza i incidencije infekcije u bolesnika liječenih kroničnom hemodijalizom]. Collegium Antropologicum, 35 (1). pp. 93-101. ISSN 0350-6134

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Abstract

Through the treatment of anaemia in dialysis patients part of the iron ions remain free in the serum which is at the bacterias disposal for growth and the strengthening of their virulence. The linear relation of the increased serum iron level and tissue iron stores in the body and the infection incidence in dialysed patients has become more emphasised. The need of a clearly defined upper threshold of the serum iron concentration limit has been mentioned in scientific journals intensely, and consequently the demand for more precise professional instructions for anaemia treatment. For the purpose of participating in these professional and scientific discussions, we have observed the relation between the iron overload of the organism and complication incidence in 120 of our haemodialysis uremic patients, with special emphasis on infections. It has been established that the sepses incidence is much higher in patients with a serum ferritin concentration above 500 microg/L, than in those patients with a ferritin level lower than the mentioned value (Chi2 = 7.857, p = 0.005). The incidence of vascular access infection is significantly higher in those patients with a serum ferritin level above 500 microg/L than in those patients with a ferritin level lower than the mentioned value (Chi2 = 23.186, p = 0.001). Furthermore, it has been determined that the incidence of total infection in patients is 3.8 episodes per 100 patients months, which is in accordance to the referral values of other authors. CONCLUSION--In the analysis of the achieved results, it has been determined that the infection incidence is significantly higher in dialysed patients with a serum iron level higher than 500 microg/L, than in those patients with lower values.

Abstract in Croatian

Tijekom liječenja anemije u dijaliziranih bolesnika dio jona željeza ostaje u serumu slobodan tako da je na raspolaganju bakterijama za rast i jačanje njihove virulencije. Sve se više ukazuje u dijaliziranih bolesnika na linearni odnos povišene razine željeza u serumu i tkivnim depoima s jedne i incidencije upale s druge strane. U stručnom se tisku sve glasnije ukazuje na potrebu jasnog određivanja gornjeg praga limita serumske koncentracije željeza, a dosljedno tome i na određivanje preciznijih stručnih uputa za liječenje anemije. U nakani da se uključimo u te stručne i znanstvene rasprave promatrali smo u 120 naših bolesnika liječenih kroničnom hemodijalizom odnos opterećenosti organizma željezom i incidencije komplikacija, a posebno infekcije. Utvrđeno je da je incidencija sepse značajno viša u ispitanika sa serumskom razinom feritina iznad 500 microg/L, nego u onih s razinom feritina nižom od navedene vrijednosti (χ2=7,857, p=0,005). Incidencija infekcije vaskularnog pristupa isto je tako značajno viša u ispitanika sa serumskom razinom feritina iznad 500 microg/L, nego u onih s razinom feritina nižom od navedene vrijednosti (χ2=23,186, p=0,001). Incidencija sveukupne infekcije u svih ispitanika iznosi 3,8 epizoda na 100 bolesnikovih mjeseci i kreće se unutar referiranih vrijednosti drugih autora. Zaključak – Raščlambom postignutih rezultata utvrđeno je da je incidencija infekcije značajno veća u dijaliziranih bolesnika sa serumskom razinom feritina višom od 500 microg/L, nego u onih s nižim vrijednostima.

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