C-A T BACH1, M R P DAVIES1, P F MOUNT1,2
1Department of Nephrology, Austin Health, Heidelberg, AUSTRALIA, 2Department of Medicine, University of Melbourne, Parkville, AUSTRALIA
Background: Sucroferric oxyhydroxide (SOH) is an iron-based phosphate binder. Studies have reported chronic use of SOH does not cause significant iron loading. We report a case of iron loading temporally associated with use of SOH in a peritoneal dialysis patient.
Case Report: A 60-year-old male patient on peritoneal dialysis was commenced on SOH, 500mg, 2 tablets, 3 times daily, for management of hyperphosphataemia. Serum ferritin rose progressively from 359 ug/L to 2074ug/L over 10 months on therapy, with a concurrent rise in transferrin saturations from 26% to 42%. Haemoglobin was stable (range ~110-120g/L), but erythropoeitin requirements fell. No iron supplementation was given. Liver function tests were normal. Investigations did not suggest inflammation or an alternative cause for hyperferritinaemia. SOH was changed to sevelamer due to concerns of iron loading. The patient received a renal transplant 2 weeks later. Ferritin and transferrin saturations began falling before transplantation. Ferritin levels fell progressively but took 12 months to normalise. Transferrin saturations fell quickly to 27% within 6 weeks of ceasing SOH. Genetic testing for C282Y and H63D mutations were negative. The clinical features score 6 on the Naranjo adverse drug reaction probability scale, indicating a probable drug reaction.
Conclusion: This is the first reported case of iron loading associated with use of SOH. While most patients taking SOH do not develop significant iron loading, it may be that a small number of patients are more susceptible to iron loading with this agent. SOH should be considered as a potential cause of unexplained hyperferritinaemia in patients receiving this treatment.
Cindy is a general medicine advanced trainee and will commence renal advanced training at Austin Health in 2021.