Proinflammatory effects of iron sucrose in chronic kidney disease

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35 Scopus citations

Abstract

Inflammation is a central component of progressive chronic kidney disease (CKD). Iron promotes oxidative stress and inflammatory response in animals and promotes progressive CKD. Parenteral iron provokes oxidative stress in patients with CKD; however, its potential to provoke an inflammatory response is unknown. In 20 veterans with CKD, 100 mg iron sucrose was administered intravenously over 5 min and urinary excretion rate and plasma concentration of monocyte chemoattractant protein-1 (MCP-1) were measured at timed intervals over 24 h. Patients were then randomized to placebo or N-acetyl cysteine (NAC) 600 mg b.i.d. and the experiment was repeated at 1 week. Iron sucrose markedly increased plasma concentration and urinary excretion rate of MCP-1 at baseline and at 1 week visits (P < 0.0001 for time effect). Urinary excretion peaked at 30 min and plasma concentration at 15 min. Plasma MCP-1 concentration fell from 164 ± 17.7 to 135 ± 17.7 pg/ml with NAC, whereas it remained unchanged from 133 ± 12.5 to 132 ± 17.7 pg/ml with placebo (P = 0.001 for visit x antioxidant drug interaction). There was a reduction in MCP-1 urinary excretion rate from visit 1 to 2. At the baseline visit, the urinary excretion rate averaged 305 ± 66 pg/min and at the second visit 245 ± 67 pg/min (mean difference 60 ± 28 pg/min, P = 0.030). There was no improvement in urinary MCP-1 excretion with NAC. In conclusion, iron sucrose causes rapid and transient generation and/or release of MCP-1 plasma concentration and increases urinary excretion rate, and systemic MCP-1 level but the urinary excretion rate is not abrogated with the antioxidant NAC. These results may have implications for the progression of CKD with parenteral iron.

Original languageEnglish (US)
Pages (from-to)1259-1263
Number of pages5
JournalKidney international
Volume69
Issue number7
DOIs
StatePublished - Apr 1 2006

Keywords

  • Chronic kidney disease
  • Inflammation
  • Iron
  • MCP-1
  • Oxidative stress

ASJC Scopus subject areas

  • Nephrology

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