Intraperitoneal deferoxamine therapy for iron overload in children undergoing CAPD

Area of Science:

• Nephrology
• Pediatric Nephrology
• Clinical Pharmacology

Background:

• Chronic iron overload is a significant concern in children with renal failure, often exacerbated by frequent blood transfusions.
• Elevated serum ferritin levels and increased liver density on computed tomography (CT) scans are indicators of hepatic iron accumulation.
• Dialysis-related porphyria cutanea tarda can occur in patients with renal failure and iron overload.

Observation:

• Three children with renal failure and chronic iron overload received intraperitoneal deferoxamine therapy for 3-6 months.
• Iron was detected in the dialysate during deferoxamine treatment, indicating significant iron removal.
• Serum ferritin levels decreased in two children achieving negative iron balance, while liver density increased in all three, irrespective of iron balance.

Findings:

• Intraperitoneal deferoxamine therapy facilitates substantial iron excretion through peritoneal dialysate.
• A strong positive correlation exists between serum ferritin levels and liver density in children with chronic renal failure.
• Despite significant iron removal, intraperitoneal deferoxamine did not decrease liver iron content as assessed by CT scan density.

Implications:

• Intraperitoneal deferoxamine is a viable option for managing iron overload in pediatric renal failure patients, promoting iron excretion.
• Monitoring liver density alongside serum ferritin may provide a more comprehensive assessment of iron overload treatment efficacy.
• Further research is needed to understand the discrepancy between iron removal in dialysate and changes in liver iron content measured by CT scan.