Vision Impairment After Iron Chelating Agent in a Patient Under Peritoneal Dialysis
DOI:
https://doi.org/10.7175/cmi.v13i1.1428Keywords:
Vision Disorders, Kidney Failure, Chronic, Peritoneal Dialysis (PD), Deferoxamine.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.
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
Published
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution Non-Commercial 4.0 Licence that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. The Publication Agreement can be downloaded here, and should be signed by the Authors and sent to the Publisher when the article has been accepted for publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
- Authors are permitted to post their work online after publication (the article must link to publisher version, in html format)