EXAMINING RADIOACTIVE IODINE’S THERAPEUTIC LANDSCAPE IN DIALYSIS-DEPENDENT CHRONIC KIDNEY DISEASE PATIENTS, A CASE SERIES

Introduction:

There are limited publications that shed light on the management of patients who undergo Radioactive Iodine (RAI) while on hemodialysis. As the number of patients undergoing dialysis grows, we see more patients with different co-morbidities such as those needing RAI. Radioactive Iodine is used to treat patients with thyroid cancer and since excretion is primarily through renal clearance, management of patients undergoing treatment and dialysis poses a challenge. Currently, no standardized guidelines exist regarding the administration of RAI dosing and the timing of dialysis in this specific population. In this case series, we present two CKD patients on dialysis who underwent RAI, with the objective of providing more information on this particular subset of patients.

Methods:

Case 1 is a 51 female, non-oliguric, known case of Papillary Thyroid Carcinoma, post Total Thyroidectomy, Hypertensive Kidney Disease on Hemodialysis. The patient underwent hemodialysis one day after RAI treatment was given with no complications. She was discharged after two days of treatment and resumed her regular hemodialysis schedule after three days post-discharge.

Case 2 is a 49 female, anuric, known case of Papillary Thyroid Carcinoma, post Total Thyroidectomy, Chronic Kidney Disease secondary to Glomerulonephritis on Hemodialysis. The patient also underwent hemodialysis one day after RAI treatment and was discharged stable three days after treatment.

Results:

Case 1 was given 105.2 mCi of Iodine-131. The subsequent dose rate was at 183 uSv/hr at 1 1-meter distance with no adverse reactions. Eight hours post-administration, the dose rate was at 144 uSv/hr at 1 meter distance. One day post-RAI, the dose rate was at 127 uSv/hr at 1 meter distance and she was scheduled for hemodialysis during the same day. Pre-dialysis, the dose rate was 105 uSv/hr at 1 meter distance while post-dialysis, the dose rate was 54 uSv/hr at 1 meter distance.

Case 2 was given an actual dose of 150.8 mCi Iodine-131. One day post-procedure, the dose rate was 164 uSv/hr at 1 meter. She was scheduled for hemodialysis afterwards, where post post-dialysis dose rate was 64 uSv/hr at 1 meter distance. 48 hours post RAI, a dose rate of 40 uSv/hr at 1 meter distance was noted. The patient was discharged without any complications.

Conclusions:

Patients on hemodialysis can be safely given RAI as long as specific measures for the timing of hemodialysis and adjustment of dosages are done appropriately. Since the demographic of patients undergoing hemodialysis and needing RAI is now emerging, data consolidation and consensus from multiple centers may be needed to set a standardized guideline for treating these patients.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.