Ocular and Auditory Toxicity in Hemodialyzed Patients Receiving Desferrioxamine

Abstract

During an 18-month period of study 41 hemodialyzed patients receiving desferrioxamine (10–40 mg/kg BW/3 times weekly) for the first time were monitored for detection of audiovisual toxicity. 6 patients presented clinical symptoms of visual or auditory toxicity. Moreover, detailed ophthalmologic and audiologic studies disclosed abnormalities in 7 more asymptomatic patients. Visual toxicity was of retinal origin and was characterized by a tritan-type dyschromatopsy, sometimes associated with a loss of visual acuity and pigmentary retinal deposits. Auditory toxicity was characterized by a mid- to high-frequency neurosensorial hearing loss and the lesion was of the cochlear type. Desferrioxamine withdrawal resulted in a complete recovery of visual function in 1 patient and partial recovery in 3, and a complete reversal of hearing loss in 3 patients and partial recovery in 3. This toxicity appeared in patients receiving the higher doses of desferrioxamine or coincided with the normalization of ferritin or aluminium serum levels. The data indicate that audiovisual toxicity is not an infrequent complication in hemodialyzed patients receiving desferrioxamine. Periodical audiovisual monitoring should be performed on hemodialyzed patients receiving the drug in order to detect adverse effects as early as possible.

High Risk of Retinal Damage by Desferrioxamine in Dialysis Patients

“…Macular changes were, therefore, very frequent in our and others' dialysis patients [12,13], even with doses that were lower than those used in individuals with normal renal function. This finding strongly suggests that patients in hemodialysis have still unde tected co-morbid factors for developing DFO-related retinopathy.…”

“…In hemodialysis patients, ocular toxicity has been reported in 17-73% of DFO-treatcd patients [12,13]. Cases et al [12] observed visual toxicity in 7 of 41 of their patients treated with 10-40 mg/kg DFO 3 times weekly.…”

“…In hemodialysis patients, ocular toxicity has been reported in 17-73% of DFO-treatcd patients [12,13]. Cases et al [12] observed visual toxicity in 7 of 41 of their patients treated with 10-40 mg/kg DFO 3 times weekly. Ravelli et al [13] reported sequen tial ophthalmological examination in 15 he modialysis patients undergoing a standard DFO test (40 mg/kg): 13 complained of re duced visual acuity and 9 had macular changes.…”

The efficacy of deferiprone on tissues aluminum removal and copper, zinc, manganese level in rabbits

“…The use of DFO in dialysis patients is not free from side-effect. In some patients, ocular toxicity, disturbances of colour vision and loss of hearing have been described [13]. So a cheap, orally active and non-toxic aluminum chelator is needed.…”

EOG as a monitor of desferrioxamine retinal toxicity

“…Unfortunately, visual disorders have been recorded after DFO infusion and it is believed that the visual toxicity is mainly of retinal origin [4]. Vision may become blurred with reduction of visual acuity, centrocaecal scotoma and some constriction of peripheral fields together with abnormalities in the electro-oculogram (EOG), electroretinogram and visual evoked potentials [5][6][7][8].…”