Journal Article

Low-dose (5 mg/kg) desferrioxamine treatment in acutely aluminium-intoxicated haemodialysis patients using two drug administration schedules

J. D. Barata, P. C. D'Haese, C. Pires, L. V. Lamberts, J. Simões and M. E. De Broe

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 11, issue 1, pages 125-132
Published in print January 1996 | ISSN: 0931-0509
e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/oxfordjournals.ndt.a027027
Low-dose (5 mg/kg) desferrioxamine treatment in acutely aluminium-intoxicated haemodialysis patients using two drug administration schedules

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Background

According to the recommendations proposed at The Consensus Conference on Diagnosis and Treatment of Aluminium Overload in End-Stage Renal Failure Patients, Paris, 1992 low-dose desferrioxamine (DFO) treatment was applied for the first time in 41 acutely aluminium-intoxicated patients.

Methods and results

DFO-related neurological/ophthalmological side-effects were observed in nine of 11 patients with a post-DFO serum aluminium level >300 μg/litre and in two patients of 30 below this level after a single administration of a 5-mg/kg dose of the chelator in the conventional way (i.e. the last hour of a dialysis session). They were no longer observed after introducing an alternative DFO administration schedule (i.e. administration of the chelator 5 h prior to the start of a haemodialysis session; group I: n=14). A significant decrease in the serum aluminium levels as well as in the post-DFO serum aluminium increment (ΔsAl) was observed during the first 6 months' course of low-dose DFO treatment in group I as well as group II (which consisted of patients receiving DFO in the conventional way; n=27). Low-dose DFO treatment was accompanied by a significant increase in the mean ±SD serum iPTH levels (group I: 174±245 up to 286±285 ng/litre; group II: 206±272 up to 409±424 ng/litre; P<0.005) and the mean corpuscular volume (group I: 80±6.4 up to 85±3.7 fL, P<0.005; group II: 76±5.0 up to 87±4.3 fL, P<0.0001). Serum ferritin levels significantly decreased in both groups. No further side-effects were observed during the DFO course. Patients in which DFO treatment could be stopped (i.e. subjects in which both serum aluminium and ΔsAl were below 50 μg/litre at two successive occasions) before the end of the 6-months' treatment course had a significantly greate residual diuresis (700±682 ml/min vs 84±109 ml/24 h). Also, residual diuresis was found to protect against aluminium intoxication as reflected by the values noted in group I versus those in group II.

Conclusions

The 5-mg/kg DFO treatment provides a safe and adequate therapy for aluminium overload. In severely aluminium-intoxicated patients presenting post-DFO serum aluminium levels above 300 μg/litre DFO should be given once weekly 5 h prior to high-extraction dialysis ensuring (i) maximal chelation of aluminium (ii) limited exposure to circulating aluminoxamine levels, and (iii) adequate removal of the latter compound. Finally, the necessity for a better communication between the local water distribution companies and the dialysis centres is a major lesson that can be drawn from this dramatic intoxication.

Keywords: desferrioxamine; aluminium intoxication; acute; administration schedule; treatment

Journal Article.  0 words. 

Subjects: Nephrology

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