Oxidative Stress and Renal Function in Pediatric Patients with Beta Thalassemia Major (β-TM) Receiving Deferiprone and Deferasirox: A Cross-Sectional, Single Center Study

Abstract

Oxidative stress in β-TM (beta-thalassemia major) patients is associated with increased of malondialdehyde (MDA) level and also decreased of superoxide dismutase (SOD) level. Deferiprone and deferasirox, which are used for the treatment of iron overload, exhibit antioxidant potential. However, various clinical studies have shown an increase in creatinine levels in pediatric patients receiving oral iron chelator. There was limited study assessed oxidative stress and impact of β-TM on the renal function, especially in children that growing up with β-TM and receiving iron chelator. Therefore, the aim of the study is to investigate renal function and oxidative stress between β-TM patients at Ulin Hospital Banjarmasin who received deferasirox and deferiprone. Ninety β-TM patients (aged 2-≤18 years) with regular iron chelators (deferiprone or deferasirox) use at Ulin Hospital between October-December 2020, were included in this cross-sectional study. Laboratory examinations included complete peripheral blood count, serum ferritin, urea, creatinine, MDA and SOD. Statistical analysis was used to compare all parameters between two groups.There was no significant difference in the levels of MDA (p= 0.663), SOD (p= 0.102), urea (p= 0.597), creatinine (p= 0.067) and glomerular filtration rate (p= 0.792) between the two groups. In this study, 9 patients had decreased GFR, of which 3 patients (33.3%) were taking DFX. Thus, 13.6% of DFX users (3 of 22 patients) and 8.8% of DFP users (6 of 68 patients) had decreased renal function. In general, the mean glomerular filtration rate (GFR) of the patients in this study ranged from 126.74± 32.71ml/kg/min/1.73m2. For conclusion, deferiprone and deferasirox had no significant difference in terms of protection against oxidative stress. However, the decline in renal function occurred slightly higher in deferasirox users. Early recognition will be an important key to prevent renal complication