The Effect of Two Types of Intravenous Iron on Phagocytic Function of Neutrophils in Hemodialysis Patients

Abstract

Intravenous (IV) iron preparations are widely used in the management of anemia in ESRD populations. In many instances IV iron preparations are administered on a routine basis with insufficient attention to the total body iron stores that finally leads to iron overload specifically iron sucrose that showed at pharmacologically-relevant concentrations significantly inhibits phagocytic function in PMNs against both Gram positive and negative bacteria (Ichii et al., 2012). We aimed to evaluate the effect of two types of IV iron on phagocytic function of neutrophils in hemodialysis patients. In the present cross over study we included 20 ESRD patients on regular hemodialysis, 12(60%) were females and 8(40%) were males. Patients were divided into 2 groups: Group I: (10) ESRD patients who received 100 mg iron sucrose then shifted to 100 mg iron dextran after wash out peroid 4 weeks. While group II: Included (10) ESRD patients who received 100 mg as a single dose of iron dextran then shifted to 100 mg iron sucrose after 4 weeks wash out peroid. Assessment of neutrophil oxidative burst index using flow cytometery and CRP titer were done before and after giving each type of IV iron. This study was conducted in Ain Shams university hospital. The protocol was in conformity to the medical ethics and informed consent from each participant. Study included patients aged between 18 and 65 years, on regular hemodialysis for at least 6 months before the study, hemodialysis sessions thrice weekly, four hours for each session using bicarbonate dialysate, low flux dialyzers and heparin as anticoagulant and serum Ferritin <800 ng/mL. While patients who suffered from fever, evidence of acute infection, active Collagen disease, liver cell failure, Immunosuppressive drugs, AIDS, malignancy, diabetes mellitus, history of parenteral iron injection in the last 4 weeks, history of blood transfusion in the last one month, hemoglobinopathies, known hypersensitivity to iron sucrose and evidence of iron overload (ferritin > 800 ng/mL and/or TSAT > 50%) were excluded from the study. All patients were subjected to the following: Full history and clinical examination including (age, sex, BMI, smoking, duration of hemodialysis, cause of renal failure, type of vascular access, symptoms or signs of active inflammation).