LOW-DOSE (5 MG KG) DESFERRIOXAMINE TREATMENT IN ACUTELY ALUMINUM-INTOXICATED HEMODIALYSIS-PATIENTS USING 2 DRUG ADMINISTRATION SCHEDULES/

Background. According to the recommendations proposed at The Consensus Conference on Diagnosis and Treatment of Aluminium Overload in End-St age Renal Failure Patients, Paris, 1992 low-dose desferrioxamine (DFO) treatment was applied for the first time in 41 acutely aluminium-into xicated patients. Methods and results, DFO-related neurological/ophtha lmological side-effects were observed in nine of 11 patients with a po st-DFO serum aluminium level >300 mu g/litre and in two patients of 30 below this level after a single administration of a 5-mg/kg dose of t he chelator in the conventional way (i.e. the last hour of a dialysis session). They were no longer observed after introducing an alternativ e DFO administration schedule (i.e. administration of the chelator 5 h prior to the start of a haemodialysis session; group I: n = 14). A si gnificant decrease in the serum aluminium levels as well as in the pos t-DFO serum aluminium increment (Delta sAl) was observed during the fi rst 6 months' course of low-dose DFO treatment in group I as well as g roup 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 u p 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 bot h groups. No further side-effects were observed during the DFO course. Patients in which DFO treatment could be stopped (i.e. subjects in wh ich both serum aluminium and Delta sAl were below 50 mu g/litre at two successive occasions) before the end of the 6-months' treatment cours e had a significantly greate residual diuresis (700 +/- 682 ml/min vs 84 +/- 109 ml/24 h). Also, residual diuresis was found to protect agai nst aluminium intoxication as reflected by the values noted in group I versus those in group II. Conclusion. The 5-mg/kg DFO treatment provi des a safe and adequate therapy for aluminium overload. In severely al uminium-intoxicated patients presenting post-DFO serum aluminium level s above 300 mu g/litre DFO should be given once weekly 5 h prior to hi gh extraction dialysis ensuring (i) maximal chelation of aluminium (ii ) limited exposure to circulating aluminoxamine levels, and (iii) adeq uate removal of the latter compound. Finally, the necessity for a bett er communication between the local water distribution companies and th e dialysis centres is a major lesson that can be drawn from this drama tic intoxication.