Four hemodialysis patients receiving deferoxamine for metal overload had fatal rhinocerebral rhizopus infections. Serious fungal infections are not commonly seen in patients on dialysis, and none of these patients had the usual risk factors for rhizopus infection. Deferoxamine is being used with increased frequency in dialysis patients for aluminum and iron overload states. We propose that there is a link between the deferoxamine therapy and this unusual infection. Deferoxamine may serve as a specific growth factor for Rhizopus species or may alter host immune function. We suggest searching for fungal organisms in patients with unexplained illnesses receiving deferoxamine.

Sometime during the reign of Tiberius (25-50 ad) Celsus wrote:A chronic malady may develop in patients who collect water under their skin. The Greeks call this hydrops. There are three species: (1) Sometimes the belly is tense. The Greeks call this tympanites.(2) Sometimes the body is rendered uneven by swellings arising here and there and all over. The Greeks call this hyposarka. (3) Sometimes, the water is all drawn within and is called ascites.

Aim: To evaluate whether factors such as acidosis and hyperphosphataemia that might cause an increased oxygen delivery to tissues could result in increased dosing requirements for intravenous erythropoietin (EPO) administration given to haemodialysis patients. Methods:The clinical records of the patients seen at the Hypertension, Nephrology, Dialysis and Transplantation Clinic from December, 2004 through August, 2005 were reviewed to identify patients who had taken intravenous erythropoietin. Two-tailed, Pearson's correlation was performed to determine correlations between any of the parameters. Analysis of variance and stepwise regression for covariance were used to evaluate the relations of demographic and clinical characteristics and laboratory variables. Analysis of covariance and K means cluster analyses were also performed to examine linkage between variables. Kendall's Tau correlation was used for correlations of non-parametric data. Results: There was a significant direct or positive correlation at the 0.01 levels between dry weight, age, intact parathyroid hormone level (PTH), and serum phosphorus and EPO dose. There was an inverse or negative correlation at that level between the serum bicarbonate and urea reduction ratio (URR) with the EPO dose at the same level while there was a weaker correlation but direct correlation between the white blood count (WBC) and EPO dose. There was significant colinearity between serum phosphorus and PTH but serum phosphorus showed a more significant correlation with EPO overall. Stepwise regression analysis for covariance revealed that phosphorus remained significantly correlated with EPO resistance after the removal of the effect of PTH while PTH lost its significance after the effect of phosphorus was removed. Conclusion: Acidosis and hyperphosphataemia are associated with apparent increased erythropoietin dosing requirements. While this study did not evaluate the mechanism of such requirements and indeed many mechanisms might be possible, a rightward shift in the oxygen-haemoglobin dissociation curve resulting in down-regulation of erythropoietin receptors is considered consistent with the data and present knowledge.

Sevelamer (but not calcium acetate) in addition to calcium carbonate appears to interfere with the bioavailability of levothyroxine.

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