E YII4*, JCG DOERY3,4, Z KAPLAN2,4, PG KERR1,4.
1Department of Nephrology, 2Haematology; 3Pathology – Monash Health; 4Department of Medicine, Monash University, Clayton, Victoria. (* medical student).
Aim: To determine the efficay and safety of desferasirox in PD patients.
Background: A 54 year old male with b-Thalassemia major developed ESRD and was managed with CAPD. Despite being untransfusable, he required concomitant management of iron overload. The iron chelator Deferasirox (Exjade) was administered orally. There was concern that excretion of iron via the peritoneal dialysate may raise the risk of iron-dependent infections (Yersinia and Rhizopus).
Methods: Whilst receiving Exjade 1000mg /day, a total collection of 12.7L of peritoneal dialysate was collected over a 24 hour period. The dialysate total iron levels were measured by ICP-mass spectrometry at 0.46mmol/L which equates to 0.33mg of Fe in total. Over a 6 month period his serum ferritin fell from 3869ug/l to 1545ug/l. There were no episodes of peritonitis.
Results: According to the deferasirox product information, 1000mg/day in this man accounts for just under the 20mg/kg/day dosage, hence giving an expected 18-20mg excretion of Fe per day (predominantly via the GIT). Since only 7-8% of the deferasirox and iron complex is excreted through the urine, the amount of Fe seen in the patient’s dialysate might be expected to be up to 1.5-1.6mg. Yet, the results of the Fe levels in the patient’s PD fluid was a meagre 0.33mg, about five times lower than expected.
Conclusion: Thus, deferasirox appears to be a safe and effective agent for iron chelation in iron overloaded peritoneal dialysis patients.