Department of Nephrology, ESOGU Faculty of Medicine, Eskisehir, Turkey.
Ren Fail. 2012;34(1):1-6. doi: 10.3109/0886022X.2011.623492. Epub 2011 Oct 21.
Iron support is an important component of treatment of anemia in hemodialysis (HD) patients. However, there are concerns about endovenous (EV) iron therapy that may cause endothelial dysfunction (ED) by increasing oxidative stress (OS) and lead to cardiovascular events. In this study, we aimed to evaluate the effects of high and repeated doses of EV iron sucrose on endothelial functions in acute and subacute phases.
We included 15 HD patients to our study. There were 16 patients with iron deficiency but normal kidney functions in control group. We also evaluated endothelium-dependent vasodilatation (EDV) and nitroglycerin-induced vasodilatation (NIV) from the brachial artery by ultrasonography at the beginning of the study, and then 200 mg EV iron sucrose was given initially to both groups for 1 h in 250 cc 0.9% saline and 4 h after the end of the infusion (acute phase) sonographic vasodilatation parameters were measured from brachial artery. These measurements and laboratory tests were repeated 1 week after the end of a total 1000 mg EV iron sucrose replacement (200 mg/week).
There was a statistically significant increase in hemoglobin and ferritin levels after the EV iron sucrose therapy in both control and patient groups. EDV values in the HD group were significantly lower than that in the control group before therapy (6.25% vs. 10.53%, p < 0.05). EV iron sucrose therapy did not alter EDV and NIV values at the 4th hour and 6th week in both control and patient groups.
According to our study, compared with the control group with normal kidney functions, HD patients had impaired endothelial functions. However, in HD patients, high and repeated doses of EV iron sucrose do not have deleterious effects on endothelial functions at acute and subacute phases and can be used safely in that patient group.
铁剂支持是血液透析（HD）患者贫血治疗的重要组成部分。然而，静脉内（EV）铁剂治疗可能通过增加氧化应激（OS）引起内皮功能障碍（ED），并导致心血管事件，这引起了人们的关注。在这项研究中，我们旨在评估高剂量和重复剂量的 EV 蔗糖铁对急性和亚急性阶段内皮功能的影响。
我们将 15 名 HD 患者纳入本研究。对照组中有 16 名铁缺乏但肾功能正常的患者。我们还通过超声心动图在研究开始时评估肱动脉内皮依赖性血管舒张（EDV）和硝酸甘油诱导的血管舒张（NIV），然后两组均在 250 cc 0.9%生理盐水输注 1 小时后给予初始 200 mg EV 蔗糖铁，输注结束后 4 小时（急性相）测量肱动脉超声血管舒张参数。这些测量值和实验室检查在总 1000 mg EV 蔗糖铁替代（200 mg/周）结束后 1 周重复进行。
EV 蔗糖铁治疗后，对照组和患者组的血红蛋白和铁蛋白水平均显著升高。HD 组 EDV 值明显低于治疗前对照组（6.25%比 10.53%，p<0.05）。EV 蔗糖铁治疗并未改变对照组和患者组在第 4 小时和第 6 周的 EDV 和 NIV 值。
与肾功能正常的对照组相比，HD 患者的内皮功能受损。然而，在 HD 患者中，高剂量和重复剂量的 EV 蔗糖铁在急性和亚急性阶段对内皮功能没有不良影响，可以在该患者组中安全使用。
