Oxidative stress and renal injury with intravenous iron-in patients with chronic kidney disease

Rajiv Agarwal, Nina Vasavada, Nadine G. Sachs, Shawn Chase

Research output: Contribution to journalArticle

176 Citations (Scopus)

Abstract

Background. Intravenous iron is widely prescribed in patients with chronic kidney disease (CKD) and can cause oxidative stress. The relationship of oxidative stress and renal injury in patients with CKD is unknown. Whether renal injury can occur at a time point when transferrin is incompletely saturated is also unclear. Methods. We conducted a randomized, open-label, parallel group trial to compare the oxidative stress induced by intravenous administration of 100 mg iron sucrose over 5 minutes and its protection with N-acetylcysteine (NAC) in 20 subjects with stage 3 or 4 CKD. Transferrin saturation was measured with urea polyacrylamide gel electrophoresis, oxidative stress by malondialdehyde (MDA) measurement by high-performance liquid chromatography, and renal injury by enzymuria and proteinuria. Reduced and oxidized glutathione and free radical scavengers as well as urinary monocyte chemoattractant protein-1 were also measured. Results. Parenteral iron increased plasma concentration and urinary excretion rate of MDA, a biomarker of lipid peroxidation, within 15 to 30 minutes of iron sucrose administration. This was accompanied by enzymuria and increase in proteinuria. In contrast, saturation of transferrin was not maximally seen until 3 hours after the end of infusion. Oxidative stress, enzymuria and proteinuria were transient and were completely resolved in 24 hours. NAC reduced acute generation of systemic oxidative stress but failed to abrogate proteinuria or enzymuria. Conclusion. Intravenous iron produces oxidative stress that is associated with transient proteinuria and tubular damage. The rapid production of oxidative stress even when transferrin is not completely saturation suggests free iron independent mechanism(s) to be operative in producing oxidative stress and transient renal injury. Long-term implications of these findings need further study.

Original languageEnglish (US)
Pages (from-to)2279-2289
Number of pages11
JournalKidney international
Volume65
Issue number6
DOIs
StatePublished - Jun 2004

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Chronic Renal Insufficiency
Oxidative Stress
Iron
Kidney
Wounds and Injuries
Proteinuria
saccharated ferric oxide
Transferrin
Acetylcysteine
Malondialdehyde
Free Radical Scavengers
Glutathione Disulfide
Chemokine CCL2
Intravenous Administration
Lipid Peroxidation
Glutathione
Urea
Polyacrylamide Gel Electrophoresis
Biomarkers
High Pressure Liquid Chromatography

Keywords

  • Anemia
  • Chronic kidney failure
  • Iron
  • Malondialdehyde
  • Oxidative stress
  • Randomized controlled trial

ASJC Scopus subject areas

  • Nephrology

Cite this

Oxidative stress and renal injury with intravenous iron-in patients with chronic kidney disease. / Agarwal, Rajiv; Vasavada, Nina; Sachs, Nadine G.; Chase, Shawn.

In: Kidney international, Vol. 65, No. 6, 06.2004, p. 2279-2289.

Research output: Contribution to journalArticle

Agarwal, Rajiv ; Vasavada, Nina ; Sachs, Nadine G. ; Chase, Shawn. / Oxidative stress and renal injury with intravenous iron-in patients with chronic kidney disease. In: Kidney international. 2004 ; Vol. 65, No. 6. pp. 2279-2289.
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