Hazardous effect of the maintenance dose of iron sucrose versus iron dextran on oxidative burst activity of neutrophils in patients on regular hemodialysis; a pilot study

Abstract

Introduction: Intravenous (IV) iron which is a potent pro-oxidant may decrease the phagocytic function of neutrophils and subsequently leads to repeated bacterial infections in patients on chronic regular hemodialysis (HD).Objectives: We aimed to evaluate the effect of IV iron dextran versus iron sucrose on oxidative burst activity of neutrophils in HD patients.Patients and Methods: A crossover study was included 20 prevalent HD patients were randomly divided into two groups; 10 patients each. Each group received a single dose of 100 mg iron sucrose or iron dextran then shifted to the other type after 4 weeks as a washout period. Patients with evidence of acute infections, diabetes mellitus, chronic liver disease, active collagen disease or any other acquired immune deficiency diseases were excluded. Patients on immunosuppressive drugs or with hypersensitivity to iron therapy or evidence of iron overload (TSAT > 50% and/or ferritin > 800 ng/mL) were also excluded. Erythropoietin maintenance dose was given to all patients. Urea reduction ratio (URR %), C-reactive protein (CRP) titer, complete blood picture and iron study were conducted. Neutrophil oxidative burst test was performed by flow-cytometry with an estimation of stimulation index before and after IV iron dosage. Results: Twenty patients (9 males, 11 females; mean age 49.40 ± 9.02 years) on chronic HD for a mean time of 10 ± 7.32 years. After 100 mg of IV iron infusion in HD patients, a highly significant difference in oxidative burst test of neutrophil cells before and after administration of iron regardless of its type was detected (P 0.05). However, a significant increase in CRP titer after administration of iron dextran was seen (P = 0.016). Conclusion: Maintenance dosage of either IV iron sucrose or iron dextran (100 mg) had a hazardous effect on the neutrophilic phagocytosis demonstrated by the significant rise in the oxidative burst index in HD patients.

Keywords

• Iron therapy
• Neutrophils
• Hemodialysis
• Flow-cytometry
• End-stage renal disease
• Oxidative burst test
• Reactive oxygen species
• Chronic kidney disease