Almost all hemodialysis patients treated with erythropoeisis-stimulating agents receive parenteral (intravenous) iron to ensure sufficient available iron during therapy.

Until recently, iron overload was considered exceptional in dialysis patients in the era of erythropoeisis-stimulating agents. Quantitative hepatic magnetic resonance imaging is now the gold standard for iron store estimation and monitoring in non-renal-patients with secondary hemosideroses and genetic hemochromatosis.

Recent hepatic magnetic resonance imaging studies of dialysis patients revealed a high frequency of iron overload and suggest a strong link between the cumulative dose of intravenous iron and the risk of hemosiderosis. The potential iron overload toxicity is now one of the most controversial topics in the management of anemia in dialysis patients.