CONCOMITANT IRON AND ALUMINUM MASS-TRANSFER FOLLOWING DEFEROXAMINE INFUSION DURING HEMOFILTRATION

Variable tissue overloading can alter the removal rate of iron and aluminum from uremics. Owing to its higher affinity to deferoxamine (DFO) and higher plasma concentrations, Fe could impair AI removal in cases of simultaneous body burden. Fe and AI plasma kinetics and mass transfer were therefore studied in 12 uremic patients with different Fe and AI status: six with normal ferritin levels (< 400 μg/L [ng/mL]), and AI 1.4 to 4.7 μmol/L (40 to 131μg/L) (group A); six with increased ferritin (> 2,000 μg/L), and AI 1.7 to 17 μmol/L (47 to 476 μg/L) (group B). DFO (40 and 80 mg/kg in a random sequence) was administered once a week during the first hour of the first hemofiltration (HF). The results show that in both groups and with both DFO doses, maximum Fe and AI mass transfer was achieved in the first and second HF, respectively. The 80-mg/kg dose of DFO significantly raised AI mass transfer in both groups, whereas Fe mass transfer was only slightly affected. Even though plasma Fe levels were almost always higher than AI, AI mass transfer eventually exceeded that of Fe, in both Fe-normal and Fe-overload patients. The bias towards AI in mass transfer was enhanced In both groups in the second HF, and at the higher DFO doses. Thus, DFO once a week reduced Fe loss to less than 30 μmol/wk in patients with normal ferritin levels. In both Fe and AI overloaded patients, AI can be removed, and AI mass transfer may often exceed Fe mass transfer, depending on the degree of tissue burden, the time from DFO infusion, and the DFO dose. © 1991, National Kidney Foundation, Inc.. All rights reserved.