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NDT Advance Access originally published online on May 30, 2008
Nephrology Dialysis Transplantation 2008 23(8):2704-2705; doi:10.1093/ndt/gfn278
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© The Author [2008].
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org


Acute kidney injury due to deferoxamine in a renal transplant patient

E-mail: rhirschberg{at}labiomed.org

Sir,

We have served as members of the Renal Safety Board for deferasirox (Exjade®, ICL670) for the past 5 years and wish to respond to a misleading comment on the renal safety profile of deferasirox that appears in the discussion section of a recent article by Clajus et al. [1], which describes a case report of acute kidney injury due to deferoxamine. The authors state that deferasirox has ‘been repeatedly shown to cause acute renal failure’, citing a recent article by Kontoghiorghes [2].

It should be pointed out that Kontoghiorghes bases many of his conclusions about the tolerability of deferasirox on post-marketing surveillance information. Such events are reported in the drug label irrespective of whether a causal link has been established. More than 30 000 patients have been treated with deferasirox outside the clinical trial setting, many of whom were elderly or had other underlying medical conditions in addition to transfusional iron overload. Although acute renal failure was reported in a very small number of patients receiving deferasirox, almost all of these patients had severe complications of their underlying haematological disease, most commonly sepsis, and the contribution of deferasirox to the renal insufficiency in these critically ill patients is quite uncertain. Having reviewed many of these cases in detail, we are very skeptical that deferasirox was responsible for the episodes of renal failure. In addition, the term ‘acute renal failure’ was probably used inappropriately in many cases to describe relatively minor increases in serum creatinine (<2 x upper limit of normal) that developed over the course of several weeks.

Conflict of interest statement. C.P. is a consultant of Novartis, Italy, for transplantation and autoimmune diseases.

Raimund Hirschberg1, William Bennett2, Jon Scheinman3, Rosanna Coppo4 and Claudio Ponticelli5

1 Division of Nephrology Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 2 Legacy Transplant Services & NorthWest Renal Clinic Portland OR 3 University of Kansas Medical Center, Kansas, MO, USA 4 Departments of Nephrology and Dialysis, Ospedale Infantile Regina Margherita, Turin 5 Department of Immunology Istituto Auxologico, Milan, Italy

References

  1. Clajus C, Becker JU, Stichtenoth DO, et al. Acute kidney injury due to deferoxamine in a renal transplant patient. Nephrol Dial Transplant (2008) 23:1061–1064.[Free Full Text]
  2. Kontoghiorghes GJ. Deferasirox: uncertain future following renal failure fatalities, agranulocytosis and other toxicities. Expert Opin Drug Saf (2007) 6:235–239.[CrossRef][Web of Science][Medline]

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This Article
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Right arrowOA All Versions of this Article:
23/8/2704-a    most recent
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