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Abstract: SA-PO611

One-Year Effect of Deferoxamine in Sickle Cell Disease with ESRD Patient on Hemodialysis

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Ledoux, Jason R., Ochsner Medical Center, New Orleans, Louisiana, United States
  • Alsaid, Jafar, Ochsner Medical Center, New Orleans, Louisiana, United States
Introduction

Sickle cell disease patient may develop Iron overload due to multiple transfusions. Iron chelation is recommended for treatment. Deferoxamine is eliminated through the kidneys and bowels. In ESRD the elimination is only by bowels. It can be removed by hemodialysis as reported. We are reporting the changes in serum Iron, Ferritin, hospital admission rates and transfusions frequency in an ESRD patient with sickle cell disease after using Deferoxamine for a year.

Case Description

29 years old patient with Sickle cell disease.
ESRD for 3 years, started with PD and transitioned to HD 3X weekly for the past year.
He had recurrent admission for painful and hemolytic crises with frequent blood transfusions.
Iron levels increased up to 235 micgm/dL (45-160) and Ferritin reached 7973 ng/ml (20-300).
Hb remains low 3-5 gm/dl (14-18).
Deferoxamine was started after review, discussion and assessment, at 1gm IV after each dialysis in June 2022 until May 2023.

Discussion

Deferoxamine is proven to be used with heavy metal intoxication. It is cleared through the kidneys and bowels. In patients with impaired renal function elimination of Deferoxamine will be reduced. Hemodialysis is reported to improve the clearance. Limited data is available on using the drug with Iron overload among dialysis patients.
In our patient, we started Deferoxamine at 1gm IV infusion over 1 hour after each dialysis for a year. It was noticed to reduce the Ferritin significantly by 48%. An insignificant reduction trend was observed in S. Iron of 23%. The monthly admission rates for the patient was increased. Other causes needs to be excluded. There was an insignificant decrease in the number of PRBC transfused monthly.

Mean annual monthly admission rate, units of PRBC transfused, S. Iron and Ferritin.
Variables2021
Mean (SE)
2022
Mean (SE)
2023
Mean (SE)

p value
Monthly admissions1.2 (0.34)2.3 (0.7)3.6 (0.7)0.001
Monthly transfusions 1.6 (0.5)1.8 (0.37)1.2 (0.4)NS
S. Iron 138 (22)108 (30)NS
S. Ferritin6375 (378)5050 (476)3360 (356)0.001