Acute Effects of Iron Sucrose and Iron Carboxymaltose on Endothelial Function in Nondialysis Chronic Kidney Disease Patients

Abstract

Background:Intravenous iron is commonly prescribed in chronic kidney disease (CKD) patients. Iron sucrose (IS) and ferric carboxymaltose (FCM) are 2 frequently used formulations. Experimental data showed that this 2 intravenous iron preparations have different potential to induce oxidative stress and by that endothelial dysfunction. Still, direct comparisons in clinical settings are rather scarce.Study Question:Are there any acute changes in endothelial function after single intravenous iron infusions of IS and FCM in nondialysis CKD patients?Study Design:This was a prospective, crossover study in which 31 patients with CKD stages 3–5 (80% stages 3 and 4, 81% female, 55% older than 60 years, 23% diabetes mellitus, and 94% arterial hypertension) who required intravenous iron as part of their routine medical care were enrolled.Measures and Outcomes:The effect of flow-mediated vasodilatation infusions containing 250-mL 10% glucose, 500-mg FCM, and 200-mg IS, both in 250-mL 0.9% saline solution, was compared. The infusions were administered over 30 minutes, 72 hours apart, in the mentioned order. Ultrasound measurement of the brachial artery flow-mediated vasodilation (FMD) performed 15 minutes before and after each infusion was used to assess endothelial function. The outcome was the post/preinfusion difference (Δ) in FMD.Results:The baseline FMD was similar before each study intervention. The arterial reactivity significantly decreased only after IS infusion [ΔFMD −2.3 (−5.65 to −0.33) vs. 1.0 (−1.49 to 1.80) after glucose, P = 0.01], but not after FCM [ΔFMD −0.8 (−2.50 to 0.65), P = 0.27 vs. glucose]. Moreover, the arterial reactivity was higher after IS as compared to FCM.Conclusions:Endothelial dysfunction seems to be acutely induced by a single dose of intravenous IS, but not by FCM, in nondialysis CKD patients.