Vision Impairment After Iron Chelating Agent in a Patient Under Peritoneal Dialysis

Chi-Feng Huang

DOI: https://doi.org/10.7175/cmi.v13i1.1428

Abstract

A 54-year-old female patient had a history of end-stage renal disease (ESRD) under continuous automatic peritoneal dialysis (CAPD) therapy for 6 years. She had underlying hypertension history under oral hypertensives (olmesartan medoxomil). She was admitted to the ward for iron chelating agent therapy due to high ferritin level (5480 ng/ml). Deferoxamine 1 gram was prescribed with intravenous drip for 24 hours for 5 days. On the fifth day, she complained about vision problems, i.e. central halo pattern vision loss. A deferoxamine-related macula edema was diagnosed. After discontinuing the medication, her vision gradually improved. After 3 months of follow up, her vision disorders recovered.

Although we reduced the dose of iron chelating agent, vision side effects also occurred in this ESRD patient.

This case taught us to perform a careful detection of vision problems before, during, and after deferoxamine therapy in order to prevent irreversible vision disorders.

Keywords

Vision Disorders; Kidney Failure, Chronic; Peritoneal Dialysis (PD); Deferoxamine.

Full Text

HTML PDF

References

  • Kidney Disease Improving Global Outcomes (KDIGO). Anemia Work Group. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney Int Suppl 2012; 2: 279-335. Available at https://kdigo.org/wp-content/uploads/2016/10/KDIGO-2012-Anemia-Guideline-English.pdf (last accessed September 2019)
  • Izzedine H, Bodaghi B, Launay-Vacher V, et al. Oculorenal manifestations in systemic autoimmune diseases. Am J Kidney Dis 2004; 43: 209-22; https://doi.org/10.1053/j.ajkd.2003.10.031
  • Evans RD, Rosner M. Ocular Abnormalities Associated with Advanced Kidney Disease and Hemodialysis. Semin Dial 2005; 18: 252-7; https://doi.org/10.1111/j.1525-139X.2005.18322.x
  • Shukla D, Virani AY. Reversible loss of vision in Malignant Hypertension. N Engl J Med 2016; 374: 1368; https://doi.org/10.1056/NEJMicm1508601
  • Gall MA, Rossing P, Skøtt P, et al. Prevalence of micro- and macroalbuminuria, arterial hypertension, retinopathy and large vessel disease in European type 2 (non-insulin-dependent) diabetic patients. Diabetologia 1991; 34: 655-61; https://doi.org/10.1007/BF00400995
  • Ravelli M, Scaroni P, Mombelloni S, et al. Acute visual disorders in patients on regular dialysis given deferoxamine as a test. Nephrol Dial Transplant 1990; 5: 945-9; https://doi.org/10.1093/ndt/5.11.945
  • Boelaert JR, Locht M. Side effects of deferoxamine in dialysis patients. Nephrol Dial Transplant 1993; 8 (suppl 1): 43-6; https://doi.org/10.1093/ndt/8.supp1.43
  • Rubinstein M, Dupont P, Doppee JP, et al. Ocular toxicity of deferoxamine. Lancet 1985; 1(8432): 817-8; https://doi.org.autorpa.mmh.org.tw/10.1016/S0140-6736(85)91473-4
  • Pengloan J, Dantal J, Rossazza C, et al. Ocular toxicity after a single intravenous dose of Desferrioxamine in 2 hemodialyzed patients. Nephron 1987; 46: 211-2; https://www.karger.com/Article/Abstract/184345#
  • Davies SC, Hungerford LL, Arden GB, et al. Ocular toxicity of high dose intravenous desferrioxamine. Lancet 1983; ii: 181-4
  • Albalate M, Velasco L, Ortiz A, et al. High risk of retinal damage by Desferrioxamine in dialysis patients Nephron 1996; 73: 726-7; https://doi.org/10.1159/000189179
  • Di Nicola M, Barteselli G, Dell’Arti L, et al. Functional and Structural abnormalities in Deferoxamine Retinopathy: A Review of the Literature. Biomed Res Int 2015; 24617; http://dx.doi.org/10.1155/2015/249617

Statistics

Abstract: 43 views
HTML: 9 views
PDF: 27 views

Refbacks

  • There are currently no refbacks.




© SEEd srl