se of Deferoxamine in the treatment of Iron Overload in patients on Dialysis: impact on bone remodeling, myocardial function and liver storage

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.