Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Lodz, Poland.
Ren Fail. 2023 Dec;45(1):2164305. doi: 10.1080/0886022X.2022.2164305.
INTRODUCTION: It has been observed that intravenous iron administration may suppress endogenous production of erythropoietin (EPO). We postulate that this effect may be mediated by increased FGF-23 secretion. AIM OF THE STUDY: To evaluate the short-term effect of intravenous iron sucrose administration on endogenous EPO secretion in patients with chronic kidney disease (CKD). MATERIALS AND METHODS: The cohort comprised 35 nondialysis patients with CKD stages 3-5. All received 100 mg of intravenous iron (III)-hydroxide sucrose complex daily for five consecutive days. Plasma EPO, iFGF-23, cFGF-23, PTH, bone alkaline phosphatase (BAP), phosphorus (PO4), calcium (Ca), and high-sensitive C-reactive protein (CRP) were measured before, and two hours after, the first and third iron infusions, and after completing iron therapy. RESULTS: EPO concentration at the end of iron treatment was significantly lower than two hours after the first iron infusion ( = 0.0003) and before the third dose ( = 0.0006) (12.6 [10.2, 41.4] mIU/mL. vs. 30.9 [15.9, 54.2] mIU/mL and 33.4 [15.4, 56.7] mIU/mL, respectively). Conversely, plasma iFGF-23 was significantly higher before the third dose (61.1 [18.6, 420.1 4] pg/mL; = 0.025) and after the course of treatment (92.1 [28.4, 878.1] pg/mL; = 0.004) compared to pretreatment value (48.4 [16.2, 420] pg/mL). cFGF-23 concentration was significantly lower than baseline after the first iron dose (491.8 [257.7, 1086.3] vs. 339.2 [75.4, 951.2] RU/mL; = 0.005) and after treatment (398.7 [90.4, 1022.3] RU/mL; = 0.025). No significant linear correlation was found between changes in plasma EPO and FGF-23. CONCLUSIONS: Although intravenous iron therapy causes parallel increase of FGF-23 and supression of endogenous EPO, these two effects seem to be independent.
简介:已经观察到静脉铁剂给药可能会抑制内源性促红细胞生成素(EPO)的产生。我们假设这种作用可能是通过增加成纤维细胞生长因子 23(FGF-23)的分泌来介导的。
目的:评估静脉蔗糖铁给药对慢性肾脏病(CKD)患者内源性 EPO 分泌的短期影响。
材料和方法:该队列包括 35 名非透析 CKD 3-5 期患者。所有患者连续 5 天每天接受 100mg 的静脉三价羟化蔗糖铁复合物。在第一次和第三次铁输注前、输注后 2 小时以及完成铁治疗后,测量血浆 EPO、iFGF-23、cFGF-23、甲状旁腺激素(PTH)、骨碱性磷酸酶(BAP)、磷(PO4)、钙(Ca)和高敏 C 反应蛋白(CRP)。
结果:铁治疗结束时的 EPO 浓度明显低于第一次铁输注后 2 小时( = 0.0003)和第三次剂量前( = 0.0006)(12.6 [10.2,41.4] mIU/mL。vs. 30.9 [15.9,54.2] mIU/mL 和 33.4 [15.4,56.7] mIU/mL)。相反,第三次剂量前的血浆 iFGF-23 明显升高(61.1 [18.6,420.1 4] pg/mL; = 0.025),治疗后(92.1 [28.4,878.1] pg/mL; = 0.004)也明显高于治疗前(48.4 [16.2,420] pg/mL)。cFGF-23 浓度在第一次铁剂量后明显低于基线(491.8 [257.7,1086.3] vs. 339.2 [75.4,951.2] RU/mL; = 0.005)和治疗后(398.7 [90.4,1022.3] RU/mL; = 0.025)。血浆 EPO 和 FGF-23 的变化之间未发现显著的线性相关性。
结论:虽然静脉铁治疗会导致 FGF-23 平行增加和内源性 EPO 抑制,但这两种作用似乎是独立的。
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