Two different modalities of iron gluconate i.v. administration: effects on iron, oxidative and inflammatory status in peritoneal dialysis patients

Abstract

Iron deficiency represents an important problem for dialysis patients. Oral iron administration is frequently ineffective, requiring parenteral administration, which may trigger severe side effects due to inflammation and/or peroxidation. The aim of the present study was to clarify the effects of parenteral iron administration on iron, inflammatory and oxidative status in peritoneal dialysis patients and compare two different modalities of injecting ferric gluconate intravenously. Twenty peritoneal dialysis patients (10M/10F, mean age 60 +/- 16 years) were given i.v. iron gluconate (62.5 mg) both concentrated (1-2 min, PULSE) and diluted in 100 ml of glucose solution (30 min, SLOW). The interval between the first and second administration was 15-60 days. Blood cell count, serum iron, total iron binding capacity (TIBC), ferritin, C-reactive protein (CRP), reactive oxygen species (ROS) concentrations and total antioxidant capacity (TAC) were measured before iron infusion (T0), after 30 min (T1) and after 24 h (T2). No patient had clinical symptoms during or within an hour of iron administration. Serum transferrin was oversaturated in 25% of cases, no matter how iron was injected. Oxidative and inflammatory status parameters were not affected by iron administration: no difference in CRP, ROS concentrations or TAC was found at any time between PULSE and SLOW group. Our findings showed that neither inflammation nor peroxidation in peritoneal dialysis patients was clinically triggered by 62.5 mg i.v. iron infusion. Both modalities were equally safe. Therefore, in the absence of clinical side effects, PULSE intravenous administration, being cheaper and not so problematic for outpatients, is preferable to SLOW.