'Oversaturation' of transferrin after intravenous ferric gluconate (FerrlecitR) in haemodialysis patients

Zanen, A. L.; Adriaansen, H. J.; Bommel, E. F. H. van; Posthuma, Rein; Jong, G.M.T. de

doi:10.1093/oxfordjournals.ndt.a027405

Cited by 123 publications

(83 citation statements)

References 15 publications

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“…This is in contrast to several recent reports on an apparent oversaturation of transferrin during iv.Fe therapy (14,15,38,50). One possible explanation for the opposite findings could arise from the study design: Before iv.Fe administration, our patients received no iv.Fe for 1 wk (washout phase).…”

Section: Discussionmentioning

confidence: 99%

Non–Transferrin-Bound Iron in the Serum of Hemodialysis Patients Who Receive Ferric Saccharate

Scheiber-Mojdehkar

Lutzky²,

Schaufler³

et al. 2004

Journal of the American Society of Nephrology

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Abstract. Intravenous iron (iv.Fe) is used to optimize response to recombinant human erythropoietin (r-HuEPO) in ESRD, but no consensus exists with respect to the best regimen to avoid transferrin "oversaturation," oxidative stress, and the occurrence of non-transferrin-bound iron (NTBI). Iv.Fe was stopped for 1 wk in 35 hemodialysis (HD) patients who were routinely receiving iv.Fe and r-HuEPO. The iv.Fe group received 100 mg of ferric saccharate (Venofer) at the end of the first HD session, whereas the time-control group was treated under the same conditions but received no iv.Fe. Serum samples were taken before the first HD session, immediately and 60 min after iv.Fe administration, and before the next HD session. Sera were analyzed for NTBI and peroxides; transferrin saturation was analyzed by urea-PAGE and Western blot. In an in vitro model system with HepG2 cells, the effects of ESRD serum on the labile iron pool (LIP) were assayed using the fluorescence calcein assay. NTBI significantly increased after iv.Fe-administration and returned to baseline values before the next HDsession. There was a shift from apo-to monoferric transferrin, but no "oversaturation" of transferrin after iv.Fe-treatment. Peroxides increased in both groups after HD. Hemodialysis decreased bioavailable iron for the LIP in HepG2-cells, whereas serum of iv.Fe-treated HD patients highly increased the LIP in these cells. A total of 100 mg of iv.Fe led to NTBI generation but not to an oversaturation of transferrin. Peroxide concentrations significantly increased during HD but were not correlated to iv.Fe administration and seemed to result from other sources of oxidative stress related to HD. NTBI can enter liver cells and increase the potentially harmful LIP.

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Section: Discussionmentioning

confidence: 99%

Non–Transferrin-Bound Iron in the Serum of Hemodialysis Patients Who Receive Ferric Saccharate

Scheiber-Mojdehkar

Lutzky²,

Schaufler³

et al. 2004

Journal of the American Society of Nephrology

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“…Differences can be partially explained by the fact that different iron supplements, rates of infusion and methods of assessment have been used by various researchers. For example, various studies have focused in different markers [8, 9, 16, 20, 22, 25, 30, 31, 34] while rates of i.v. infusion varied from 5–6 min [9, 31, 38] to 20–30 min [8, 32].…”

Section: Discussionmentioning

confidence: 99%

“…Intravenous iron is usually administered in rapid infusion rate (during a 30-min infusion), which can lead to ‘oversaturation’ of transferrin [8]. Transferrin oversaturation is indicative of increased amounts of nontransferrin-bound iron, which represents circulating iron that is not tightly bound to transferrin [9].…”

Section: Introductionmentioning

confidence: 99%

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Slow Intravenous Iron Administration Does Not Aggravate Oxidative Stress and Inflammatory Biomarkers during Hemodialysis: A Comparative Study between Iron Sucrose and Iron Dextran

et al. 2007

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Background/Aims: Fast intravenous (i.v.) iron administration during hemodialysis (HD) is associated with the augmentation of oxidative stress and the increase in inflammatory biomarkers, which are also induced by the hemodialysis procedure itself. The aim of this study was to investigate if slow i.v. iron administration would aggravate the status of oxidative stress and inflammatory biomarkers during a hemodialysis session. Methods: Twenty dialysis patients 30–92 years of age that were iron replete and had values for hemoglobin, transferrin saturation and serum ferritin among recommended goals were evaluated in three separate hemodialysis sessions. In the first session patients did not receive any iron treatment, whereas during the second and the third session patients received slow (60 min) i.v. infusions of 100 mg of iron sucrose and 100 mg of iron dextran, respectively. Blood samples were drawn before the hemodialysis session, 15 min after the end of iron administration and at the end of the hemodialysis session in all occasions, for the measurement of markers of oxidant stress (oxidized LDL and ischemia-modified albumin) and inflammation (high-sensitivity C-reactive protein, interleukin-6 and tumor necrosis factor-α). Results: Oxidized LDL was not significantly altered during hemodialysis and this pattern was similar between the three occasions studied. In contrast, ischemia-modified albumin was significantly increased and this effect was also not different between the net hemodialysis and the occasions of iron administration. High-sensitivity CRP, IL-6 and TNF-α were all significantly elevated during hemodialysis and again both types of iron administration did not produce significant changes in this pattern. Conclusion: We did not find an increase in the markers of oxidation/inflammation studied, after slow i.v. iron administration during hemodialysis session.

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“…Another potential adverse effect of intravenous iron therapy is a clinical syndrome of acute iron toxicity (nausea, facial reddening, and hypotension) which has been attributed to oversaturation (>100%) of transferrin. This has been described with rapid infusion of ferric gluconate (62.5 mg to 125 mg within 30 minutes) in a study of 20 dialysis patients 36 . However, a recent report disputed the existence of this effect (i.e., oversaturation of transferrin) by demonstrating that two laboratory assays for measurement of serum iron yield misleading results for transferrin saturation if performed within 24 hours after infusion 37 .…”

Section: Current Status Of Perisurgical Erythropoietin Therapymentioning

confidence: 99%

Current Status of Perisurgical Erythropoietin [Therapy

Goodnough

2000

Transfus Alt Transfus Med

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SUMMARY Recombinant human erythropoietin (EPO) therapy has been approved for use in patients undergoing autologous blood donation (ABD) in Japan, the European Union, and Canada since 1993,1994, and 1996 respectively, and is now approved for perisurgical adjuvant therapy in Canada, Australia, the U.S. and the European Union (Table 1)1. Emerging strategies to improve the dose‐response relationship between erythropoietin therapy and red cell production include low dose EPO and intravenous iron therapy, to be addressed in this discussion.

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'Oversaturation' of transferrin after intravenous ferric gluconate (FerrlecitR) in haemodialysis patients

Cited by 123 publications

References 15 publications

Non–Transferrin-Bound Iron in the Serum of Hemodialysis Patients Who Receive Ferric Saccharate

Non–Transferrin-Bound Iron in the Serum of Hemodialysis Patients Who Receive Ferric Saccharate

Slow Intravenous Iron Administration Does Not Aggravate Oxidative Stress and Inflammatory Biomarkers during Hemodialysis: A Comparative Study between Iron Sucrose and Iron Dextran

Current Status of Perisurgical Erythropoietin [Therapy

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