Hemodialysis of chronic kidney failure patients requiring ablative radioiodine therapy

Abstract

Ablative radioiodine therapy is the standard treatment for thyroid carcinoma, but as (131)I is predominantly cleared by renal excretion, its clearance will be reduced in patients with chronic kidney disease, particularly in anuric patients on dialysis. The high dose of radioactivity used in the procedure results in an increased risk of radioactive exposure to the patient, the dialysis staff, and the machinery. Here, we describe how to successfully hemodialyze patients with chronic kidney failure requiring ablative (131)I therapy for thyroid cancer while minimizing risks to the patient and dialysis staff. With appropriate training, hemodialysis treatments can be safely delivered to patients receiving radiotherapy.

Radioyodo como tratamiento de hipertiroidismo en un paciente en hemodiálisis: Caso clínico

“…Así mismo, pareciera que con las medidas de seguridad estándar, la exposición del personal a cargo del paciente es mínima, asemejándose a la radiación recibida por una radiografía de rodillas o tórax 14,15 , lo que está dentro de lo permitido en las normas nacionales e internacionales para personas que no trabajan habitualmente con radiación y que es de 1 mSv/año 16,17 . En conclusión, el administrar 17 mCi de 131-I como tratamiento para el hipertiroidismo en este caso resultó efectivo y seguro, lográndose el control de la enfermedad, lo que nos permite considerar este tratamiento como una excelente alternativa a la tiroidectomía para los pacientes en hemodiálisis.…”

Can radioiodine be administered effectively and safely to a patient with severe chronic kidney disease?

“…Thus, the preparation of dialysis equipment for HD should be performed in the room adjacent to the patient's room (Fig. ), and a different dialysis team should perform subsequent procedures . Some authors assert that one dialysis session should be performed by three teams: the first – preparing and starting the procedure, the second – performing the procedure and the third – completing and preparing equipment for subsequent procedures (washing, sterilisation) .…”

“…Using I‐131 in patients with ESRD gives rise to a number of difficulties. The only conclusions regarding I‐131 treatment thus far have been derived from single case studies . The half‐life of I‐131 in these patients is longer, and its levels are higher.…”

“…24 Murcutt et al suggested that a I-131 dose of approximately 3000 MBq should be administered immediately after the HD procedure, followed by another dose after 40 h, and another after 48 h, after which the patients can be permitted to leave the radiation therapy department. 25 They suggested this protocol because the radiation measured with a dosimeter following the procedure was comparable to background radiation. Based on a retrospective analysis of five cases, Alevizaki et al made a somewhat different suggestion.…”

Briefly noted

“…Protecting dialysis staff from radiation from a dialysis patient who received ablative doses of 131 I (3000 MB q ) required careful preparation; it included lead shields between the patient and staff and radioprotective overshoes, gloves, and apron during treatment (16). Treatment was performed 39 hours after dosing.…”