Use of deferasirox (Exjade) for iron overload in peritoneal dialysis patients

Yii, Erwin; Doery, James C.G.; Kaplan, Zane; Kerr, Peter G.

doi:10.1111/nep.13389

Cited by 9 publications

(8 citation statements)

References 5 publications

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“…Deferoxamine (DFO) was first used to chelate iron and aluminum, [18][19][20] it is rarely used, due to its side effects, particularly infectious. 21 We chose DFX, which has already been studied in dialysis patients [22][23][24][25] It has the advantage of having a long half-life (8-16 h), allowing a single daily intake for better therapeutic compliance. Moreover, the elimination of chelated iron is mainly by biliary route, without risk for anuric patients.…”

Section: Discussionmentioning

confidence: 99%

Hemosiderosis in chronic dialysis patients: Monitoring the response to deferasirox by quantitative hepatic magnetic resonance imaging

Bekhechi

Chiali

Khelil

et al. 2023

Hemodialysis International

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Introduction: Hemosiderosis of chronic dialysis has always been a frequent phenomenon in dialysis; formerly related to blood transfusions before the advent of Erythropoiesis Stimulating Agents (ESA), it is currently in connection with the use of massive doses of injectable iron, to ensure the full therapeutic efficacy of ESA. Few studies have looked at the therapeutic aspect of iron chelators in the dialysis population.Methods: We followed 31 dialysis patients treated for secondary hemosiderosis with deferasirox (DFX) at the dose 10 mg/kg/day, by hepatic MRI from September 2017 to September 2021, in order to evaluate the efficacy of iron chelators on the reduction of liver iron concentration (LIC). The diagnosis of hemosiderosis was carried for a value of the LIC > 50 μmol/g of dry liver.Results: Chelation resulted in a significant reduction in liver iron burden as measured by liver MRI: (201.4 ± 179.9 vs. 122.6 ± 154.3 μmol/g liver)

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Section: Discussionmentioning

confidence: 99%

Hemosiderosis in chronic dialysis patients: Monitoring the response to deferasirox by quantitative hepatic magnetic resonance imaging

Bekhechi

Chiali

Khelil

et al. 2023

Hemodialysis International

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“…The majority of these reports are cases and experiences on small number of subjects on the use of these iron chelation therapies in CKD and ESKD with little adverse effects reported. These reports include the use of iron chelation medications for elevated iron, aluminum, and calcium levels in severe kidney disease and ESKD in HD [3,[5][6][7][8][9][10][11][12][14][15][16][17][18][19][20][21][22][23][24][26][27][28][29][30][31][32], PD [13], CAPD [4,23,24,27,28], and CCPD [24]. Please refer to Table 1 for brief information provided on these reports and the following are some examples of these reports from the study.…”

Section: Discussionmentioning

confidence: 99%

Safety of Iron Chelation Therapies in Kidney Disease

Nguyen¹,

Wang²

2023

Preprint

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Background: Iron chelation medications (desferoxamine, desferasirox, desferiprone) are used to manage iron overload. These medications are partially excreted via the kidneys, desferoxamine and desferiprone excretes primarily in the urine, and desferasirox had about 8% excreted in the urine. Their use in severe kidney disease and dialysis patients is caution as “avoided” concerning adverse effects; however, there are reports safe use. This manuscript reviews the literature in this population. Data Sources: Pubmed: desferasirox, deferiprone, deferoxamine, kidney disease, ESKD, Dialysis. Case reports and case series that described experiences with using iron chelation medications in ESKD patients are included. Data also gathered from reading-related sources. Results: This is a review of desferoxamine, desferasirox, and deferiprone use in kidney disease from 1976 to the present time. Table 1 provides a summary of findings. These are mostly reports and brief descriptions of the experiences used in severe kidney disease and dialysis, but lack of randomized control trials and small number of participants. Conclusions: Iron chelation medications are important for treating iron overload but concerns with adverse effects. Due to limited medications available to treat iron overload in patients with severe kidney disease, their safe use has been reporting in the literature. This is an area that warrants further research.

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“…Moreover, Yii et al 12 reported a case of 54-year-old male with b-thalassemia major and end-stage renal disease (ESRD) was managed with continuous ambulatory peritoneal dialysis (CAPD) and required management of iron overload despite not being able to receive transfusions. DFX was administered orally at a dose of 1000 mg/day, and a total of 12.7L of peritoneal dialysate was collected over a 24-hour period with low levels of iron seen in the fluid.…”

Section: Challenges and Concernsmentioning

confidence: 99%

Deferasirox in Patients with Chronic Kidney Disease: Assessing the Potential Benefits and Challenges

Nashwan,

Yassin

2023

JBM

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Chronic kidney disease (CKD) is a major global health concern, affecting millions of people worldwide. The progressive decline in kidney function often necessitates renal replacement therapy, such as hemodialysis (HD) or peritoneal dialysis (PD), to maintain a patient’s health. Iron overload, which is common in CKD patients on dialysis, can lead to severe complications, including cardiovascular disease and infections where most of the existing iron chelators are deemed unsuitable due to their suboptimal clearance in patients with compromised renal function, it becomes a significant challenge to effectively manage iron overload. Deferasirox (DFX), an oral iron chelator, has emerged as a promising treatment option for managing iron overload in these patients. However, the use of DFX comes with its unique set of challenges, such as its cost, potential side effects, and the need for close monitoring of patients, as well as the noticeable scarcity of comprehensive and rigorous clinical studies confirming its efficacy and safety of DFX. In this review, we delve into both the promising prospects and the emerging challenges associated with DFX use in managing CKD patients on HD or PD, striving for a comprehensive understanding that informs better clinical practice and patient care.

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Use of deferasirox (Exjade) for iron overload in peritoneal dialysis patients

Cited by 9 publications

References 5 publications

Hemosiderosis in chronic dialysis patients: Monitoring the response to deferasirox by quantitative hepatic magnetic resonance imaging

Hemosiderosis in chronic dialysis patients: Monitoring the response to deferasirox by quantitative hepatic magnetic resonance imaging

Safety of Iron Chelation Therapies in Kidney Disease

Deferasirox in Patients with Chronic Kidney Disease: Assessing the Potential Benefits and Challenges

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