Side-effects of desferrioxamine in dialysis patients

Boelaert, Johan R.; Locht, M. de

doi:10.1093/ndt/8.supp1.43

Cited by 67 publications

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“…50 However, it is not well tolerated, and infusions are required on each dialysis session for many months to be effective. 51 Since the advent of ESAs and better water-purification techniques, iron and aluminum overload have ceased to be major problems in the majority of patients on dialysis, and so this drug is now rarely used. …”

Section: Iron Chelation Therapymentioning

confidence: 99%

How I treat renal complications in sickle cell disease

Sharpe

Thein

2014

Blood

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Renal disease is one of the most frequent and severe complications experienced by patients with sickle cell disease; its prevalence is likely to increase as the patient population ages. We recommend regular monitoring for early signs of renal involvement and a low threshold for the use of hydroxyurea as preventative measures for end-stage renal disease. Once renal complications are detected, a careful assessment of the patient is required to rule out other causes of renal disease. Proteinuria and hypertension should be managed aggressively and the patient referred to a specialist nephrology center when progressive decline in renal function is noted. For the few patients who develop advanced chronic kidney disease, timely planning for dialysis and transplantation can significantly improve outcome, and we recommend an exchange blood transfusion policy for all patients on the transplant waiting list and for those with a functioning graft. Alongside the invasive treatment regimes, it is important to remember that renal failure in conjunction with sickle cell disease does carry a significant burden of morbidity and that focusing on symptom control has to be central to good patient care.

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Section: Iron Chelation Therapymentioning

confidence: 99%

How I treat renal complications in sickle cell disease

Sharpe

Thein

2014

Blood

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“…[4][5][6] Desferrioxamine (DFO), used as chelation therapy to reduce transfusion induced iron overload, can cause ophthalmological disorders and high frequency sensorineural hearing loss. [7][8][9] Sensorimotor neurotoxicity, associated with high dose DFO treatment has also been reported. 10 In this study we evaluated patients with b-thalassaemia clinically and electrophysiologically, and investigated whether factors such as age, clinical severity of thalassaemia (homozygous b or intermedia), antibodies against hepatitis C virus (HCV), ferritin levels, haematocrit (Ht), and history of transfusions, splenectomy, or DFO treatment are associated with abnormal findings.…”

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confidence: 99%

Axonal sensorimotor neuropathy in patients with -thalassaemia

Stamboulis

Vlachou²,

Drossou-Servou³

et al. 2004

Journal of Neurology, Neurosurgery & Psychiatry

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Objective: The purpose of this study was to investigate the prevalence of peripheral neuropathy in patients with bthalassaemia. Methods: Thirty six patients with a mean age of 29.2¡8.2 years and 17 healthy controls with a mean age of 27.6¡9.1 were included in this study. Measurements included the neuropathy symptoms score (NSS), the neuropathy disability score (NDS) as well as nerve conduction studies of two motor (ulnar and peroneal) and two sensory (ulnar and sural) nerves of the right limbs. Results: A mainly sensory axonal polyneuropathy was present in 19 out of 36 patients (52.7%). Eight out of these 19 patients also had abnormal NDS values. The neuropathy correlated significantly with the age of the patients and the hematocrit. However, it did not correlate with the presence of antibodies against HCV, the ferritin levels, or with a history of transfusions, desferrioxamine treatment, or splenectomy. Conclusions: This study showed a high prevalence of a predominantly sensory neuropathy in patients with bthalassaemia. The electrophysiological data suggest that the underlying pathology is an axonopathy. Chronic hypoxia of the nerves resulting from severe anaemia may contribute to the pathogenesis of this neuropathy.T halassaemia comprises a heterogeneous group of hereditary disorders characterised by a decrease in the production of one or more globin chains. Multiple complications can result from chronic anaemia on one hand to transfusion related haemosiderosis on the other. The peripheral nervous system, however, is rarely affected. Myopathic syndromes 1-3 and peripheral neuropathy have been reported. [4][5][6] Desferrioxamine (DFO), used as chelation therapy to reduce transfusion induced iron overload, can cause ophthalmological disorders and high frequency sensorineural hearing loss. [7][8][9] Sensorimotor neurotoxicity, associated with high dose DFO treatment has also been reported. 10In this study we evaluated patients with b-thalassaemia clinically and electrophysiologically, and investigated whether factors such as age, clinical severity of thalassaemia (homozygous b or intermedia), antibodies against hepatitis C virus (HCV), ferritin levels, haematocrit (Ht), and history of transfusions, splenectomy, or DFO treatment are associated with abnormal findings. PATIENTS AND METHODSWe examined a consecutive series of 36 patients with thalassaemia (19 women, 17 men; mean age 29.2¡8.2 years, range 16-58) followed up at two tertiary referral centres.Patients with diabetes or other known possible causes of neuropathy were excluded from the study. Thirty two had homozygous b-thalassaemia and four b-thalassaemia intermedia. All patients had normal vitamin B 12 , folic acid, and serum protein electrophoresis and immunofixation. No patient had clinical evidence of visual or auditory dysfunction. The control group consisted of 17 healthy individuals (12 women, 5 men; mean age 27.6¡9.1 years, range 16-55).In all patients the electrophysiological studies were performed by the same investigator. Standard procedures were ...

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“…Thus, five studies were evaluated: a prospective double-blind randomized controlled trial [16], three randomized clinical trials [17–19], and one historical cohort [20]. All studies were evaluated and classified as having a low risk of bias and adequate methodological quality by the Cochrane referential [13].…”

Section: Resultsmentioning

confidence: 99%

“…One study [20] provided strong evidence of a link between nasal colonization and bloodstream infection caused by S. aureus . In that study, patients who developed infection were transiently recolonized by S. aureus strains identical to the pretreatment colonized strains.…”

Section: Resultsmentioning

confidence: 99%

Screening and treatment for Staphylococcus aureusin patients undergoing hemodialysis: a systematic review and meta-analysis

et al. 2014

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BackgroundThis study was performed to evaluate the effectiveness of surveillance for screening and treatment of patients with chronic kidney disease undergoing hemodialysis and colonized by Staphylococcus aureus.MethodsA systematic review and meta-analysis were performed. The literature search involved the following databases: the Cochrane Controlled Trials Register, Embase, LILACS, CINAHL, SciELO, and PubMed/Medline. The descriptors were “Staphylococcus aureus”, “MRSA”, “MSSA”, “treatment”, “decolonization”, “nasal carrier”, “colonization”, “chronic kidney disease”, “dialysis”, and “haemodialysis” or “hemodialysis”. Five randomized controlled trials that exhibited agreement among reviewers as shown by a kappa value of >0.80 were included in the study; methodological quality was evaluated using the STROBE statement. Patients who received various treatments (various treatments group) or topical mupirocin (mupirocin group) were compared with those who received either no treatment or placebo (control group). The outcomes were skin infection at the central venous catheter insertion site and bacteremia.ResultsIn total, 2374 patients were included in the analysis, 626 (26.4%) of whom were nasal carriers of S. aureus. The probability of S. aureus infection at the catheter site for hemodialysis was 87% lower in the mupirocin group than in the control group (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.05–0.34; p < 0.001). The risk of bacteremia was 82% lower in the mupirocin group than in the control group (OR, 0.18; 95% CI, 0.08–0.42; p < 0.001). No statistically significant difference in bacteremia was observed between the various treatments group (excluding mupirocin) and the control group (OR, 0.77; 95% CI, 0.51–1.15; p = 0.20).ConclusionsTwenty-six percent of patients undergoing hemodialysis were nasal carriers of S. aureus. Of all treatments evaluated, topical mupirocin was the most effective therapy for the reduction of S. aureus catheter site infection and bacteremia in patients undergoing chronic hemodialysis.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2369-15-202) contains supplementary material, which is available to authorized users.

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Side-effects of desferrioxamine in dialysis patients

Cited by 67 publications

References 0 publications

How I treat renal complications in sickle cell disease

How I treat renal complications in sickle cell disease

Axonal sensorimotor neuropathy in patients with -thalassaemia

Screening and treatment for Staphylococcus aureusin patients undergoing hemodialysis: a systematic review and meta-analysis

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