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The Effect of Low-Dose Deferoxamine on Anemia in Iron-Overloaded Hemodialysis Patients
並列摘要
Background: Iron-overloaded anemia is frequently encountered in hemodialysis (HD) patients despite of high-dose of recombinant human erythropoietin (r-HuEPO) has widely used. Deferoxamine (DFO) had been shown to improve iron utilization. This study was to assess the effect of low-dose DFO on anemia in r-HuEPO-resistant, iron-overloaded HD patients. Methods: Twelve HD patients had r-HuEPO-resistant (＞200U/kg/wk s.c) normocytic anemia and iron overload, defined as transferrin saturation index (TSI) ＞25%, and serum ferritin ＞800 μg/L. Patient received DFO (5 mg/kg) infused during the last hour of each dialysis session for 8 weeks (wk). Serum levels of aluminum before DFO (Albasal) and 42-48 hours after the 1st dose of DFO (Alpost-DFO) treatment were checked. Hemoglobin (Hb), hematocrit (Hct), serum iron (SI), total iron-binding capacity (TIBC), serum ferritin, and TSI were measured weekly. DFO response was defined as Hb and/or Hct got 10% increment. Results: After 8 wks' DFO therapy, 5 patients were responders (R) (Hb: 8.2±0.2→9.5±0.3 g/L, p＜0.01) and 7 patients were non-responders (Non-R) (Hb: 8.3±0.3→8.1±0.2 g/L). Hb increased after 2 wks of DFO treatment in R. Three of the R remained had stable Hb 2 months after DFO cessation. The percentage of patients with diabetes (80% vs 14%, p＜0.05), levels of pre-DFO serum total Ca^(+2) (10.9±0.5 vs 9.4±0.3 mg/dl, p＜0.05) were higher in R than Non-R. The Alpost-DFO (50.8±1.7 vs 38.5±5.1 μg/L, p＞0.05) and the increment from Albasal to Alpost-DFO (28.0±7.1 vs 16.0±1.7 μg/L, p＞0.05) tend to be higher but did not reach statistical significant level. None of the patients had DFO-related adverse effects. Conclusions: A positive effect of low dose DFO treatment was only observed in some patients (42%) especially in diabetic patients. A higher dose or longer treatment using low dose of DFO might be needed in Non-R.
延伸閱讀
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