Low dose desferrioxamine can improve erythropoiesis in iron-overload hemodialysis patients without side effects.
OBJECTIVE
Multiple blood transfusions were often required to treat anemia in uremia patients before the era of recombinant human erythropoietin (r-HuEPO). Iron overload thus frequently occurred in chronic hemodialysis patients. Desferrioxamine (DFO) is an effective chelating agent, which can remove excessive iron and can enhance erythropoiesis. Large dose DFO treatment is a therapy associated with the development of severe complications. In this study, a low dose DFO regime was used to treat iron overloaded hemodialysis patients. The efficacy and side effects of this regiment were evaluated.


METHODS
Eight iron overloaded chronic hemodialysis patients were enrolled in this study. All patients received DFO 500 mg intravenously twice-a-week for eight months. Serum aluminum, transferrin saturation (TFS) and r-HuEPO requirement were recorded before and after DFO treatment. Serum ferritin and hematocrit (Hct) were measured before, during, and after the DFO withdrawal period. All patients were evaluated and followed closely during treatment.


RESULTS
Changes in aluminum, TFS and r-HuEPO dosage were unremarkable (p > 0.05). Hct increased significantly after eight months of DFO treatment (from 25.3% to 27.0%, p < 0.05). Ferritin level was reduced by 43.2% at the end of treatment and an evident decline of ferritin was achieved after four months of treatment (2102 ng/mL to 1166 ng/mL, p < 0.05). All patients tolerated the treatment well and no complications were found.


CONCLUSIONS
Low dose DFO can chelate iron effectively in chronic hemodialysis patients. This treatment can enhance erythropoiesis without adverse effects.
Lee
C T
CT
Division of Nephrology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan. stectlee@ms13.hinet.net
Liao
S C
SC
Hsu
K T
KT
Lam
K K
KK
Chen
J B
JB
D000740:Anemia / Q000188:drug therapy; D002614:Chelating Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D003676:Deferoxamine / Q000008:administration & dosage* / Q000627:therapeutic use; D004920:Erythropoiesis / Q000187:drug effects*; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D019190:Iron Overload / Q000188:drug therapy* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D006435:Renal Dialysis
D002614:Chelating Agents; D011994:Recombinant Proteins; D004921:Erythropoietin; D005293:Ferritins; D003676:Deferoxamine