Kidney Week

Abstract: SA-PO215

The Cross-Talk Between Bone and Iron Overload in Hemodialysis Patients

Session Information

• Vascular Calcification, Nephrolithiasis, Bone
  November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 401 Bone and Mineral Metabolism: Basic

Authors

• Guapyassu Machado, Hanna Karla Andrade, Laboratorio de Fisiopatologia Renal, LIM16, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil

Hanna Karla Andrade Guapyassu Machado,

• dos Reis, Luciene, Laboratorio de Fisiopatologia Renal, LIM16, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil

Luciene dos Reis,

• Nunes, Lucas Acatauassu, Laboratorio de Fisiopatologia Renal, LIM16, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil

Lucas Acatauassu Nunes,

• Oliveira, Ivone Braga de, Laboratorio de Fisiopatologia Renal, LIM16, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil

Ivone Braga de Oliveira,

• Silva, Cleonice, Laboratorio de Fisiopatologia Renal, LIM16, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil

Cleonice Silva,

• Dominguez, Wagner, Laboratorio de Fisiopatologia Renal, LIM16, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil

Wagner Dominguez,

• Moyses, Rosa M.A., Laboratorio de Fisiopatologia Renal, LIM16, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil

Rosa M.A. Moyses,

• Custodio, Melani, Laboratorio de Fisiopatologia Renal, LIM16, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil

Melani Custodio,

• Jorgetti, Vanda, Laboratorio de Fisiopatologia Renal, LIM16, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil

Vanda Jorgetti,

Background

Chronic kidney disease (CKD) has several complications, including mineral and bone disorder (MBD) and anemia, whose correction can favor iron overload. Little is known about the effects of iron overload on bone, as well as of Deferoxamine (DFO) treatment.

Methods

We prospectively evaluated the effects of 12-month of DFO therapy on CKD-MBD markers and bone histomorphometry in 18 hemodialysis patients. Osteocytic proteins expression was quantified through immunohistochemistry (DMP1, MEPE, Sclerostin, FGF23, OPG, RANKL, DKK1 and CD44), and bone marrow iron positive cells (CellsFe+) were counted. During follow-up, we maintained CKD-MBD therapy to keep serum PTH in the target range.

Results

DFO decreased markers of iron overload, as well as CellsFe+. Few changes in CKD-MBD markers were seen (Image). Bone histomorphometry showed an increase in trabecular separation and a decrease in the osteoblast surface. Mineralization defect was present in most patients (67%), which was not corrected with DFO (61%). We found a significant increase in DMP1 and a decrease in DKK1 expression after DFO. No significant changes were seen in the other proteins.

Conclusion

Although few histomorphometric changes were seen after DFO therapy, it seems that bone marrow iron overload is associated with a suppression in DMP1, a protein involved in bone mineralization. In addition, the reduction in CellsFe⁺ might be involved with the decreased DKK1 expression, suggesting that iron accumulation in bone marrow might affect the osteocytic expression of proteins that are involved and bone mineralization and formation. Therefore, iron supplementation must be done cautiously in CKD patients.

Funding

• Government Support – Non-U.S.