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

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) (p = 0.000) and in mean ferritin level: (2058.8 ± 2004.9 vs. 644.2 ± 456.6 ng/mL) (p = 0.002). A gain of 1.1 g/dL in mean hemoglobin level: (10.5 ± 1.6 vs. 11.6 ± 2.0 g/dL) (p = 0.006). A significant increase in mean albumin level: (43 ± 5.5 to 46.2 ± 6.1 g/L) (p = 0.04). The therapeutic response was clearly influenced by the cause of overload, longer in polytransfused patients (p = 0.023) and the degree of overload assessed by MRI (p = 0.003) and ferritin level (p = 0.04).

Conclusion

DFX, prescribed at a dose of 10 mg/kg/day, resulted in a significant reduction in hepatic iron burden as measured by liver MRI and ferritin. The therapeutic response was clearly influenced by blood transfusions and the degree of iron overload.