Oxidative stress markers in predicting response to treatment with ferric carboxymaltose in nondialysis chronic kidney disease patients.
Abstract | BACKGROUND: METHODS: Patients (n = 47) with non-dialysis CKD stages 3 - 5 (mean eGFR: 26 ± 10.4 mL/min/1.73 m2) and iron-deficiency anemia ( hemoglobin < 11 g/dL, transferrin saturation (TSAT) index < 20%, and/or ferritin < 100 ng/mL) received a single injection of 1,000 mg of ferric carboxymaltose (FCM) and were observed for 12 weeks. Based on erythropoietic response (defined as ⥠1 g/dL increase in hemoglobin level), patients were classified as responders or non-responders. Baseline conventional markers of iron status (TSAT and ferritin), inflammatory markers ( C-reactive protein and IL-6), OS markers ( oxidized LDL, protein carbonyl groups, erythrocyte superoxide dismutase, and glutathione peroxidase (GPx)), and catalase activity were measured. RESULTS: FCM resulted in a significant increase in hemoglobin, TSAT, and ferritin (10 ± 0.7 vs. 11.4 ± 1.3 g/dL, p < 0.0001; 14.6 ± 6.4% vs. 28.9 ± 10%, p < 0.0001; 67.8 ± 61.7 vs. 502.5 ± 263.3 ng/dL, p < 0.0001, respectively). Responders and non-responders were 34 (72%) and 13 (28%), respectively. Age, baseline hemoglobin, estimated glomerular filtration rate, parathyroid hormone, and use of ESA or angiotensin-modulating agents were similar in both groups. Responders showed a tendency towards lower TSAT than non-responders (13.6 ± 6.5% vs. 17.2 ± 5.6%, p = 0.06) but similar ferritin levels. Inflammatory markers were similar in both groups. eGPx activity was lower in non-responders compared to responders (103.1 ± 50.9 vs. 144.9 ± 63.1 U/g Hb, p = 0.01, respectively), although the other proteins, lipid oxidation markers, and enzymatic antioxidants did not differ between the two groups. In the multivariate adjusted model, odds (95% CI) for achieving erythropoietic response to FCM were 10.53 (1.25 - 88.16) in the third tertile of eGPX activity and 3.20 (0.56 - 18.0) in the second tertile compared to those in the lowest tertiles (p = 0.02). CONCLUSIONS: Decreased eGPx activity has adverse influences on response to FCM, suggesting that impaired erythrocyte antioxidant defense may be involved in the response to iron therapy in CKD patients.
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Authors | Mercedes Prats, Ramon Font, Carmen García, Mònica Muñoz-Cortés, Carmen Cabré, Manel Jariod, Marta Romeu, Montserrat Giralt, Alberto Martinez-Vea |
Journal | Clinical nephrology
(Clin Nephrol)
Vol. 81
Issue 6
Pg. 419-26
(Jun 2014)
ISSN: 0301-0430 [Print] Germany |
PMID | 24691014
(Publication Type: Journal Article)
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Chemical References |
- Biomarkers
- Ferric Compounds
- Hematinics
- Hemoglobins
- ferric carboxymaltose
- Maltose
- Glutathione Peroxidase
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Topics |
- Adult
- Aged
- Aged, 80 and over
- Anemia, Iron-Deficiency
(blood, diagnosis, drug therapy)
- Biomarkers
(blood)
- Drug Administration Schedule
- Erythrocytes
(drug effects, metabolism)
- Erythropoiesis
(drug effects)
- Female
- Ferric Compounds
(administration & dosage, therapeutic use)
- Glutathione Peroxidase
(blood)
- Hematinics
(administration & dosage, therapeutic use)
- Hemoglobins
(metabolism)
- Humans
- Injections, Intravenous
- Male
- Maltose
(administration & dosage, analogs & derivatives, therapeutic use)
- Middle Aged
- Multivariate Analysis
- Odds Ratio
- Oxidative Stress
- Predictive Value of Tests
- Renal Insufficiency, Chronic
(blood, diagnosis, drug therapy)
- Time Factors
- Treatment Outcome
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