The Effect of Intravenous Iron on Oxidative Stress in Hemodialysis Patients at Various Levels of Vitamin C

Eiselt, J; Ráček, Jaroslav; Opatrný, K; Trefil, Ladislav; Stehlík, Pavel

doi:10.1159/000096474

Cited by 21 publications

(15 citation statements)

References 60 publications

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“…1) [7,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58], representing 24 single-arm or cohort studies and 10 parallel-arm RCT; 32 studies (94%) were published in full-text articles and 2 (6%) were scientific abstracts. The characteristics of the individual studies are displayed in table 1.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Intravenous Iron Therapy for Functional Iron Deficiency Anemia in Hemodialysis Patients: A Meta-Analysis

Susantitaphong¹,

Alqahtani²,

Jaber³

2014

Am J Nephrol

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Background: Studies on benefits of intravenous iron therapy among hemodialysis patients with functional iron deficiency anemia have shown conflicting results. We conducted a meta-analysis to assess the efficacy and safety of intravenous iron in this subset of patients. Methods: We searched MEDLINE (through December 2012), the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov for single-arm studies and randomized controlled trials (RCT) that examined the effect of intravenous iron for functional iron deficiency anemia in hemodialysis patients on anemia parameters and markers of oxidative stress and inflammation. Studies of absolute iron deficiency were excluded. Random-effect model meta-analyses were used to compute changes in outcomes of interest. Results: We identified 34 studies (2,658 patients), representing 24 single-arm studies, and 10 parallel-arm RCT. In the analyses of the study arms, intravenous iron therapy resulted in a significant increase in hemoglobin, serum ferritin, transferrin saturation rate, serum iron, reticulocyte hemoglobin content as well as a significant decrease in the percentage of hypochromic erythrocytes and erythropoietin dose. There were significant increases in plasma malonyldialdehyde level and thiobarbituric acid-reactive substances, and a decrease in neutrophil respiratory burst. The analyses of the RCT revealed less robust net changes in these parameters, and there was no increased risk of adverse events including infections, cardiac events and mortality. Conclusions: Intravenous iron therapy for functional iron deficiency anemia in hemodialysis patients improves anemia parameters but exerts some effects on markers of oxidative stress that are of unclear clinical significance. The long-term safety and efficacy of this treatment strategy requires further study.

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Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Intravenous Iron Therapy for Functional Iron Deficiency Anemia in Hemodialysis Patients: A Meta-Analysis

Susantitaphong¹,

Alqahtani²,

Jaber³

2014

Am J Nephrol

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“…However, an effect of vitamin C on lipid peroxidation cannot be ruled out in this study, because vitamin C not only enhances iron absorption, but can also increase intracellular peroxidation via an iron-dependent reaction [47]. As an anti-oxidant, vitamin C can also affect lipid oxidation dose-dependently [48]. …”

Section: Iron and Oxidative Stressmentioning

confidence: 99%

Iron, Oxidative Stress and Gestational Diabetes

2014

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Both iron deficiency and hyperglycemia are highly prevalent globally for pregnant women. Iron supplementation is recommended during pregnancy to control iron deficiency. The purposes of the review are to assess the oxidative effects of iron supplementation and the potential relationship between iron nutrition and gestational diabetes. High doses of iron (~relative to 60 mg or more daily for adult humans) can induce lipid peroxidation in vitro and in animal studies. Pharmaceutical doses of iron supplements (e.g., 10× RDA or more for oral supplements or direct iron supplementation via injection or addition to the cell culture medium) for a short or long duration will induce DNA damage. Higher heme-iron intake or iron status measured by various biomarkers, especially serum ferritin, might contribute to greater risk of gestational diabetes, which may be mediated by iron oxidative stress though lipid oxidation and/or DNA damage. However, information is lacking about the effect of low dose iron supplementation (≤60 mg daily) on lipid peroxidation, DNA damage and gestational diabetes. Randomized trials of low-dose iron supplementation (≤60 mg daily) for pregnant women are warranted to test the relationship between iron oxidative stress and insulin resistance/gestational diabetes, especially for iron-replete women.

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“…Vitamin C may also act as a pro-oxidant via the reduction of ferric ion. Hemodialysis patients who received 100 mg of iron sucrose and vitamin C intravenously had an increase in oxidative stress comparable to patients given iron alone (Eiselt et al, 2006); however, this finding was not confirmed by Shi et al (2005). This suggests that combination treatment of high doses of iron and vitamin C by intravenously route, should be avoided in anemic hemodialysis patients.…”

Section: Vitaminsmentioning

confidence: 81%