What chelation therapy options are available for patients with iron overload, and how do I determine the appropriate choice?

Available Chelation Therapy Options for Iron Overload: The provided UK guideline context (NG203) on chronic kidney disease and anaemia management does not specifically detail chelation therapy options for iron overload. It primarily focuses on iron therapy management, monitoring iron status, and avoiding iron overload by monitoring serum ferritin and transferrin saturation levels. Chelation therapy options such as deferoxamine, deferiprone, or deferasirox, commonly used in iron overload conditions like thalassaemia or haemochromatosis, are not discussed in this guideline.

Determining the Most Appropriate Choice for Individual Patients: Although chelation therapy is not covered, the guideline emphasizes careful monitoring of iron status to prevent iron overload, recommending routine serum ferritin measurements every 1 to 3 months and transferrin saturation assessments to guide iron therapy dosing and avoid excess iron accumulation. Decisions on iron therapy should consider patient preferences, clinical context, and iron status markers, with serum ferritin levels ideally kept below 800 micrograms/litre and dose review when ferritin reaches 500 micrograms/litre to prevent overload ¹.

In clinical practice, the choice of chelation therapy (when indicated) depends on factors such as the severity of iron overload, patient tolerance, comorbidities, and route of administration, but these specifics are beyond the scope of the provided guideline.