Abstract: TH-PO498

Prospective Comparative Pilot Study of the Short Term Efficacy and Oxidative Stress Effects of Various IV Iron Therapies in Iron Deficient CKD Patients

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 305 CKD: Clinical Trials and Tubulointerstitial Disorders

Author

  • Zeidan, Ahmed, Hull & East Yorkshire Hospitals, NHS Trust, Hull, United Kingdom
Background

Iron deficiency is common in chronic kidney disease (CKD) and usually leads to anaemia which is associated with fatigue, reduced quality of life and poorer clinical outcomes. Treatment with oral iron is often insufficient and guidelines recommend intravenous (i.v.) iron as an option for the treatment of iron deficiency anaemia in certain clinical situations.
Reports have raised safety concerns regarding the potential increase in oxidative stress reactions and effects on cardiovascular events related to changes in endothelial function.
In this study we hypothesized that CKD patients who receive intravenous iron, although efficacy may be similar, there may be differences in the effects of iron preparation on the acute generation of oxidative stress markers and clinical effects on endothelial function.

Methods

Patients were randomised in a 1:1:1:1 ratio to intervention with one of 3 iron preparations (Cosmofer, Venofer at 200mg single dose or Monofer at 200mg or high single dose 1000mg). All patients underwent baseline assessments and following iron infusion, at 1 day, 1 week, 1 month and 3 monthly intervals. At each visit a SF-36, Pulse Wave Velocity (PWV) and blood samples for the assessment of renal function, changes in haemoglobin, iron markers, and markers of oxidative stress and endothelial function were collected.

Results

I.V. iron led to a rise in storage iron within the first 24 hours of administration and by one week a maximal rise with all iron preparations. Monofer 1000mg produced the most significant rise and reduced over the subsequent period. There was a rise in TS% within hours to levels within a toxic range (>80% for some irons). Venofer produced the greatest rise, while with Monofer this rise was more gradual in the first 24 hours.
The most significant improvement in SF-36 score over the 3 month follow-up period was seen in patients who received Monofer.
Acutely i.v. iron did not affect measures of endothelial function, but there was a trend in the reduction in PWV over the 3 month period.

Conclusion

All studied parenteral iron preparations led to a rise in storage and circulating iron. Those producing a saturation approaching 100% may cause an increase in catalytic iron which may lead to increased oxidative stress (under evaluation). Paradoxically there was a fall in PWV suggesting benefit in endothelial function.

Funding

  • Commercial Support