Proinflammatory effects of iron sucrose in chronic kidney disease

Research output: Contribution to journalArticle

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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
Pages (from-to)1259-1263
Number of pages5
JournalKidney International
Volume69
Issue number7
DOIs
StatePublished - Apr 2006

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saccharated ferric oxide
Chemokine CCL2
Chronic Renal Insufficiency
Cysteine
Iron
Oxidative Stress
Antioxidants
Placebos
Veterans
Drug Interactions
Blood Proteins

Keywords

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

ASJC Scopus subject areas

  • Nephrology

Cite this

Proinflammatory effects of iron sucrose in chronic kidney disease. / Agarwal, Rajiv.

In: Kidney International, Vol. 69, No. 7, 04.2006, p. 1259-1263.

Research output: Contribution to journalArticle

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