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Efficacy of hepatic computed tomography to detect iron overload in chronic hemodialysis
E Cecchin1, S De Marchi, F Querin
1Department of Nephrology, Santa Maria degli Angeli Hospital, Pordenone, Italy.
Insights
Hepatic computed tomography density (HCTD) is a more effective diagnostic tool than serum ferritin for detecting iron overload in hemodialysis patients. HCTD offers higher sensitivity and specificity for identifying excessive hepatic iron.
Area of Science:
- Radiology
- Nephrology
- Hepatology
Background:
- Iron overload is a concern in patients with chronic kidney disease on hemodialysis.
- Idiopathic hemochromatosis is a genetic disorder causing excessive iron accumulation.
- Accurate diagnosis of iron overload is crucial for patient management.
Purpose of the Study:
- To compare the diagnostic efficacy of hepatic computed tomography density (HCTD) with serum ferritin for detecting iron overload.
- To evaluate HCTD and serum ferritin in uremic patients on maintenance hemodialysis (HD) and patients with idiopathic hemochromatosis (IHC).
Main Methods:
- CT scanning of the liver was performed on 10 IHC patients, 38 HD patients, and 40 healthy subjects.
- Measurements included HCTD, serum ferritin, transferrin saturation, and liver iron concentration.
- Histochemical grading and direct liver iron concentration measurement were used to define iron overload.
Main Results:
- HCTD showed positive correlations with liver iron concentration and serum ferritin in both IHC and HD patients.
- HCTD demonstrated higher sensitivity, specificity, and predictive values than serum ferritin for detecting iron overload in HD patients.
- HD patients with specific HLA antigens associated with IHC had higher iron levels and HCTD values.
Conclusions:
- HCTD is a valuable and effective tool for diagnosing iron overload in patients undergoing maintenance hemodialysis.
- HCTD provides superior diagnostic performance compared to serum ferritin for hepatic iron assessment.
- The study highlights the utility of HCTD in differentiating iron overload states.
Abstract:
The diagnostic efficacy of hepatic computed tomography density (HCTD) in comparison with serum ferritin for the detection of iron overload was investigated in uremic patients on maintenance hemodialysis (HD) and in patients with idiopathic hemochromatosis (IHC). Ten IHC patients, 38 HD patients and 40 healthy subjects underwent the CT scanning of the liver and determination of percent saturation of transferrin, serum ferritin concentration and HLA typing. Liver iron content was determined by histochemical grading and direct measurement of liver iron concentration either in IHC patients or in HD patients. Nineteen HD patients were considered to have iron overload on the basis of liver iron concentration exceeding 3.6 mumol/100 mg dry weight. The mean +/- SD values of HCTD in healthy subjects, IHC patients, HD patients with iron overload and without iron overload were 60.2 +/- 5.6, 79 +/- 5.6, 71.4 +/- 3.6, 58 +/- 3.8 Hounsfield units, respectively. HCTD showed positive correlations with liver iron concentration and serum ferritin either in IHC patients or in HD patients. The analysis of the diagnostic efficacy of HCTD in comparison with serum ferritin for the detection of excessive hepatic iron in HD patients demonstrated that HCTD had higher sensitivity, specificity, positive and negative predictive values. Cut-off points were arbitrarily fixed to 66 Hounsfield units for HCTD, 400 micrograms/liter for serum ferritin and 3.6 mumol/100 mg dry weight for liver iron concentration. Seventeen HD patients who possessed the histocompatibility antigens associated with IHC, namely HLA-A3 and/or HLA-B7 and/or HLA-B14, had liver iron concentration, serum ferritin and HCTD values higher than those of the HD patients without these "hemochromatosis alleles".(ABSTRACT TRUNCATED AT 250 WORDS)