Academic Renal Research Department, Hull University Teaching Hospitals NHS Trust and the Hull York Medical School, Kingston upon Hull, UK.
PenCTU, Peninsula Medical School (Faculty of Heath), Plymouth, UK.
Sci Rep. 2022 Apr 27;12(1):6853. doi: 10.1038/s41598-022-10717-8.
Iron deficiency commonly affects patients with chronic kidney disease and has an important burden in disease trajectory and quality of life; nonetheless current guidelines do not advocate treatment of iron-deficiency without anemia in this patient group. Concerns exist regarding the potential effects of intravenous iron on oxidative stress, inflammation, and endothelial function. As part of a multicenter double-blinded randomized controlled clinical trial, we examined the effects of a single dose of intravenous iron vs. placebo on biomarkers of oxidative stress, inflammation and endothelial function in non-anemic iron deficient patients (serum ferritin < 100 μg/L and/or transferrin saturation < 20%) with chronic kidney disease (stage 3b-5). Fifty-four individuals were randomized to receive ferric derisomaltose (n = 26) or placebo (n = 28). Ferric derisomaltose was associated with a non-significant decrease in mean F2-isoprostane and no effect on thiobarbituric acid reactive substances when compared to placebo throughout follow up. No effect on inflammatory markers was observed. A modest but statistically significant rise in E-selectin was noted in the intravenous iron group at 1 month and 3 month follow-up (p = 0.030 and p = 0.002 respectively). These results suggest ferric derisomaltose administration in non-dialysis dependent chronic kidney disease patients who are iron deficient does not induce prolonged oxidative stress or inflammation. Larger trials are required to quantify the benefit of intravenous iron administration in this patient group.
缺铁症常影响慢性肾脏病患者，并在疾病进程和生活质量方面造成重大负担；尽管如此，当前的指南并不主张在该患者群体中治疗无贫血的缺铁症。人们对静脉铁剂对氧化应激、炎症和内皮功能的潜在影响存在担忧。作为一项多中心、双盲、随机对照临床试验的一部分，我们研究了单次静脉铁剂与安慰剂对无贫血缺铁症（血清铁蛋白 < 100μg/L 和/或转铁蛋白饱和度 < 20%）的慢性肾脏病（3b-5 期）患者氧化应激、炎症和内皮功能生物标志物的影响。54 名患者被随机分配至接受 Ferrlecit（n=26）或安慰剂（n=28）治疗。与安慰剂相比，Ferrlecit 在整个随访期间对 F2-异前列腺素的平均水平无显著降低作用，也无对硫代巴比妥酸反应物质的影响。对炎症标志物无影响。静脉铁剂组在 1 个月和 3 个月随访时 E-选择素略有但具有统计学意义的升高（p=0.030 和 p=0.002）。这些结果表明，在非透析依赖的慢性肾脏病患者中，给予缺铁症患者 Ferrlecit 不会引起长期的氧化应激或炎症。需要更大规模的试验来量化该患者群体中静脉铁剂治疗的获益。
