Proteinuria and chelator-associated renal dysfunction in β-thalassemia major: insights from a single-center clinical study

Introduction : Transfusion-dependent β-thalassemia major (β-TM) is increasingly complicated by renal injury related to iron overload and chelation. This study aimed to evaluate albuminuria/proteinuria in β-TM and their association with chelation regimen. Methods : Cross-sectional single-center study (2018–2019) of 44 β-TM patients and 30 controls. Patients received deferasirox (Exjade), deferiprone (Ferriprox), deferoxamine (Desferal), or combined deferiprone+deferoxamine. Serum creatinine and estimated creatinine clearance (Schwartz/MDRD) were recorded; first-morning urine albumin/protein and creatinine were used to compute ACR and PCR. Results : ACR and PCR were higher in β-TM than controls (p=0.015; p=0.023) and increased with age, peaking at 48–57 years (ACR 20.9 g/mol; PCR 42.0 g/mol). Deferasirox showed the highest ACR/PCR, followed by deferiprone and deferoxamine; combined therapy had the lowest values. Conclusions : Albuminuria and proteinuria are common in β-TM and relate to age and chelation type, supporting routine ACR/PCR monitoring and individualized chelation to reduce nephrotoxicity.