Deferoxamine to treat Iron Overload in patients on Dialysis: effect on bone, myocardial and liver
- Conditions
- Iron
- Registration Number
- RBR-3rnskcj
- Lead Sponsor
- Hospital das Clinicas da Universidade de Sao Paulo
- Brief Summary
Introduction: Iron supplementation is a critical component of anemia therapy in patients with chronic kidney disease. However, serum iron, ferritin, and transferrin saturation, used to guide iron replacement, are far from being considered optimal, as they can be influenced by malnutrition and inflammation. Currently, there is a trend to increase iron supplementation targeting high ferritin levels, although the long-term risk is overlooked. Objective: to test treatment with desferrioxamine on iron tissue accumulation. Methods: This is a prospective non-randomized study. We enrolled 28 patients with chronic kidney disease on hemodialysis with high serum ferritin (> 1000 ng/ml) and tested the effects of a 1-year deferoxamine treatment, accompanied by a withdrawal of iron administration on laboratory markers (iron status, inflammatory and mineral and bone markers), heart, liver and iliac crest iron deposition (quantitative magnetic resonance imaging), and bone biopsy (histomorphometry and counting of the number of iron positive cells in the bone marrow). Results: Twenty patients completed the study. Magnetic resonance imaging parameters showed that no patient had heart iron overload, but they all presented it in the liver and bone, which was confirmed by bone histology. After therapy, ferritin decreased but neither hemoglobin levels nor erythropoietin dose changed. A significant decrease in hepcidin was observed. Iron accumulation improved in the liver and bone, reaching normal values only in bone. No significant change in turnover, mineralization or volume was observed. Conclusion: Our data suggest that treatment with deferoxamine was safe and could improve iron accumulation, measured through magnetic resonance imaging and histomorphometry. Whether magnetic resonance imaging would be considered a standard tool to investigate bone marrow iron accumulation deserves further investigation.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Data analysis completed
- Sex
- Not specified
- Target Recruitment
- Not specified
Adult patient on maintenance hemodialysisl; serum ferritin higher than 1000 ng/ml
Active smoking; Active use of alcohol; Previous use of desferoxamine
Study & Design
- Study Type
- Intervention
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Expected outcome 1: We expected to find a significant (p<0.05) reduction on iron storage in the heart, liver and bones, evaluated by magnetic resonance imaging from baseline to one year;Found outcome 1: There was a significant decrease in serum iron, transferrin saturation, and ferritin after one year, evaluated through magnetic resonance imaging, although 9 patients (45%) remained with a ferritin level higher than that preconized. Eighteen patients (90%) improved liver accumulation. Regarding the iliac crest, all patients improved and reached normal values. There was no iron accumulation in the heart.
- Secondary Outcome Measures
Name Time Method Expected outcome 2: We expected to find a change in bone remodelling;Found outcome 2: There was no change in bone remodelling, mineralization or volume.