Health Technology Assessment Reports 1986. Number 8. Hemoperfusion in Conjunction with Deferoxamine for the Treatment of Aluminum Toxicity or Iron Overload in Patients with End-Stage Renal Disease

摘要

Deferoxamine (DFO) is an effective chelator of both iron and aluminum. When administered to end-stage renal disease (ESRD) patients with aluminum or iron overload, it forms a dialysable metallic-DFO complex. Hemofiltration in conjunction with DFO in series with hemodialysis has been shown to significantly enhance the clearance of the complexed aluminum or iron. The use of DFO alone frequently required several years of treatment to effectively lower toxic levels of iron or aluminum. The more efficient removal of DFO complexes during hemoperfusion serves to shorten the required treatment time and minimize exposure to the potential toxicity of the DFO. Numerous case reports support the safety and efficacy of the technique in enhancing the removal of iron and/or aluminum in ESRD patients. However, despite the clinical efficacy of DFO in treating some patients with aluminum toxicity, this use of DFO remains in the category of use of an approved drug for an 'unlabeled' indication. Data are lacking that would define the expected benefits from hemoperfusion with DFO in treating symptomatic ESRD patients with iron overload. Despite the fact that hemoperfusion results in iron clearance, the added benefit of this added treatment over DFO alone remains to be demonstrated in individual patients.