Hemosiderosis in chronic dialysis patients: Monitoring the response to deferasirox by quantitative hepatic magnetic resonance imaging

Abstract

Introduction: Hemosiderosis of chronic dialysis has always been a frequent phenomenon in dialysis; formerly related to blood transfusions before the advent of Erythropoiesis Stimulating Agents (ESA), it is currently in connection with the use of massive doses of injectable iron, to ensure the full therapeutic efficacy of ESA. Few studies have looked at the therapeutic aspect of iron chelators in the dialysis population.Methods: We followed 31 dialysis patients treated for secondary hemosiderosis with deferasirox (DFX) at the dose 10 mg/kg/day, by hepatic MRI from September 2017 to September 2021, in order to evaluate the efficacy of iron chelators on the reduction of liver iron concentration (LIC). The diagnosis of hemosiderosis was carried for a value of the LIC > 50 μmol/g of dry liver.Results: Chelation resulted in a significant reduction in liver iron burden as measured by liver MRI: (201.4 ± 179.9 vs. 122.6 ± 154.3 μmol/g liver)

Deferasirox in Patients with Chronic Kidney Disease: Assessing the Potential Benefits and Challenges

“… 15 These findings suggest that DFX, prescribed at a dose of 10 mg/kg/day, can be effective in reducing iron overload in dialysis patients and may have additional benefits in improving anemia and hypoalbuminemia. 15 …”

“…A recent study by Bekhechi et al 15 evaluated the efficacy of DFX on reducing liver iron concentration (LIC) in 31 dialysis patients (30 HD, and 1 PD) with secondary hemosiderosis quantified by magnetic resonance imaging (MRI). The chelation therapy resulted in a significant reduction in LIC, mean ferritin level, and a gain in mean hemoglobin and albumin levels.…”

“…The chelation therapy resulted in a significant reduction in LIC, mean ferritin level, and a gain in mean hemoglobin and albumin levels. 15 The therapeutic response was influenced by the cause and degree of overload. 15 These findings suggest that DFX, prescribed at a dose of 10 mg/kg/day, can be effective in reducing iron overload in dialysis patients and may have additional benefits in improving anemia and hypoalbuminemia.…”

“…For patient B, ferritin levels showed only a mild improvement initially before increasing again. Patient A had an episode of asymptomatic hypocalcemia Bekhechi et al 15 2023 Algeria Longitudinal Study 31 30 HD 1 PD 10 mg/kg/day Chelation with DFX resulted in a significant reduction in liver iron burden and ferritin level, as well as an increase in mean hemoglobin and albumin levels. The therapeutic response was influenced by the cause and degree of iron overload.…”

“…15 The therapeutic response was influenced by the cause and degree of overload. 15 These findings suggest that DFX, prescribed at a dose of 10 mg/kg/day, can be effective in reducing iron overload in dialysis patients and may have additional benefits in improving anemia and hypoalbuminemia. 15 Table 1 presents a comprehensive overview of significant research findings pertaining to the utilization of DFX in managing patients with CKD who are undergoing HD or PD.…”