Abstract
A 76-year-old man was introduced to maintenance hemodialysis in February 2006 due to gradually progressed renal failure following right nephrectomy for kidney cancer in 1995. The patient was referred to our department in May 2008 because of a right adrenal tumor associated with erythropoietin-resistant anemia. The adrenal tumor was probably a metastasis from kidney cancer. On magnetic resonance imaging, the liver showed a markedly low intensity on T2-weighted images, suggesting hemochromatosis. In addition, a serum level of ferritin was markedly elevated at 2,314 ng/mL. Iron overload might have been due to excessive intravenous iron administration as well as frequent blood transfusion. Following extirpation of the adrenal tumor, bone marrow biopsy was performed. The patient was diagnosed as having myelodysplastic syndrome : ringed sideroblasts comprised 20% of sideroblasts. Considering the physical condition of the patient, periodic blood transfusion was performed to treat anemia. Simultaneously, iron overload was treated with an oral chelating agent, deferasirox, starting in June 2008. The dose of deferasirox was gradually increased from 500 mg daily to the maximum dose of 1,250 mg daily while monitoring serum ferritin levels. Then, the dose was reduced when the serum ferritin level became less than 1,000 ng/mL. The only adverse event of deferasirox was diarrhea, which was well controlled with oral medication. In February 2009, after 9 months of deferasirox administration, the serum ferritin level was 467 ng/mL. Subsequently, administration of deferasirox was ceased. This is the first report in Japan of deferasirox administration to a dialytic patient. This agent would be one of the treatment options for iron overload even in hemodialysis patients.
