Abstract
We evaluated pattern and clinical correlates of renal T2* measurements in adult β-thalassemia major (β-TM) patients. Ninety β-TM patients (48 females, 38.15 ± 7.94 years), consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia network, underwent T2* magnetic resonance imaging (MRI) for quantification of iron overload (IO) in kidneys, liver, pancreas, and heart. Ten (11.1%) patients showed renal IO (T2* < 31 ms). Global kidney T2* values did not show a correlation with gender, age, splenectomy, regular transfusions or chelation starting age, pre-transfusion hemoglobin, and serum ferritin levels. Global kidney T2* values showed an inverse correlation with MRI liver iron concentration (LIC) values (R = − 0.349; p = 0.001) and a positive correlation with global pancreas T2* values (R = 0.212; p = 0.045). Frequency of renal IO was significantly higher in patients with cardiac IO than in patients without cardiac IO (50.0% vs. 6.3%; p = 0.001). A significant inverse association was detected between global kidneys T2* values and lactate dehydrogenase (LDH) (R = − 0.529; p < 0.0001). In multivariate regression analysis, MRI LIC and LDH were the strongest predictors of global kidney T2* values. A MRI LIC > 4.83 mg/g dw predicted the presence of renal IO (sensitivity = 90.0%; specificity = 61.2%). Global kidney T2* values were inversely correlated with uric acid (R = − 0.269; p = 0.025). In conclusion, in adult β-TM patients, renal iron deposition is not common and is linked to both hemolysis and total body iron overload.
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Acknowledgements
We would like to thank all the colleagues involved in the E-MIOT project (https://emiot.ftgm.it/) and all patients for their cooperation. This work is generated within the European Reference Network on Rare Hematological Diseases (ERN-EuroBloodNet).
Funding
The E-MIOT project received “no-profit support” from industrial sponsorships (Chiesi Farmaceutici S.p.A. and Bayer). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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AM conceived the study, analyzed the data, interpreted the results, and wrote the paper. LB analyzed the renal T2* images. VP developed the software for image analysis. LP was responsible for data collection. AS, TC, FM, CA, PG, and AB collected the data. LR contributed to the interpretation of the results. FC supervised the study. All authors contributed to critical revision of the manuscript and read and approved the final version.
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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Ethics Committee of Area Vasta Nord Ovest (protocol code 56664, date of approval October 8, 2015).
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Meloni, A., Barbuto, L., Positano, V. et al. Pattern and clinical correlates of renal iron deposition in adult beta-thalassemia major patients. Clin Exp Med 23, 3573–3579 (2023). https://doi.org/10.1007/s10238-023-01133-x
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DOI: https://doi.org/10.1007/s10238-023-01133-x