efficacy of vitamin e on renal function and preventing proximal tubulopathy caused by iron chelation therapy in thalassemia major patients: a randomized controlled clinical trial

Background: acute kidney injury and proximal tubulopathy, resulting from deferasirox administration, contribute significantly to acquired kidney failure. the role of antioxidants in preventing acute kidney injury remains inconclusive. objectives: this study aimed to investigate the efficacy of vitamin e in preventing acute kidney injury and proximal tubulopathy in thalassemia major patients undergoing treatment with deferasirox (nanojade). methods: this study employed a randomized controlled trial conducted at the thalassemia center of amirkabir hospital in arak, iran. sixty patients with thalassemia major receiving nanojade at 20 mg/kg were included. the vitamin e group (n = 30) received a daily dose of 400 iu for a month, while the control group (n = 30) did not receive any vitamin e.the primary outcome measure was acute kidney injury (aki), defined as a greater than 50% increase in serum creatinine levels after seven days of deferasirox administration. additionally, proximal tubulopathy was assessed using serum phosphate (p), venous blood gas (vbg), and urinalysis (u/a) after one month. also, the glomerular filtration rate (gfr) and blood urea nitrogen to creatinine ratio (bun/cr) were compared between the two groups. results: no aki or proximal tubulopathy occurrences were observed in either group, thus limiting the investigation into the preventive effect of vitamin e in these conditions. however, several noteworthy findings emerged from our analysis. regarding gfr and blood urea nitrogen to creatinine ratio (bun/cr), there was no significant difference between the vitamin e and control groups after one month (p = 0.985 and p = 0.063, respectively). the increase in serum creatinine levels during the first week was significantly lower in the vitamin e group than in the control group (p = 0.019). however, there was no difference after one month (p = 0.984). notably, the vitamin e group exhibited a significantly lower decrease in serum bicarbonate (hco3) and ph after a month (p = 0.013 and p = 0.003, respectively). the two groups had no significant differences regarding serum phosphate reduction (p = 0.391). conclusions: administering vitamin e for one week effectively prevents an increase in serum creatinine levels and prevents the decrease of deferasirox-induced ph and hco3 in thalassemia patients. however, it does not significantly affect the gfr.