Hydroxide Sucrose Research Articles

Manipulation of iron status on cerebral blood flow at high altitude in lowlanders and adapted highlanders

Cerebral blood flow (CBF) increases during hypoxia to counteract the reduction in arterial oxygen content. The onset of tissue hypoxemia coincides with the stabilization of hypoxia-inducible factor (HIF) and transcription of downstream HIF-mediated processes. It has yet to be determined, whether HIF down- or upregulation can modulate hypoxic vasodilation of the cerebral vasculature. Therefore, we examined whether: 1) CBF would increase with iron depletion (via chelation) and decrease with repletion (via iron infusion) at high-altitude, and 2) explore whether genotypic advantages of highlanders extend to HIF-mediated regulation of CBF. In a double-blinded and block-randomized design, CBF was assessed in 82 healthy participants (38 lowlanders, 20 Sherpas and 24 Andeans), before and after the infusion of either: iron(III)-hydroxide sucrose, desferrioxamine or saline. Across both lowlanders and highlanders, baseline iron levels contributed to the variability in cerebral hypoxic reactivity at high altitude (R2 = 0.174, P < 0.001). At 5,050 m, CBF in lowlanders and Sherpa were unaltered by desferrioxamine or iron. At 4,300 m, iron infusion led to 4 ± 10% reduction in CBF (main effect of time p = 0.043) in lowlanders and Andeans. Iron status may provide a novel, albeit subtle, influence on CBF that is potentially dependent on the severity and length-of-stay at high altitude.

Treatment protocol with alternative iron drugs in patients with an allergic reaction during iron replacement therapy

In our study, we aimed to show that alternative iron salts containing different additives are safe to use in patients who have type 1 hypersensitivity reactions to iron drugs and need iron replacement therapy. Materials and methods: Between January 2022 and June 2022, patients who had previously developed type 1 hypersensitivity reactions with iron preparations and needed iron replacement were included in the study. The study was designed retrospectively. Skin tests were first performed on patients to demonstrate a type 1 hypersensitivity reaction. If skin tests were negative and there was no history of life-threatening anaphylaxis, oral provocation tests were continued. If the absence of variability in symptoms and perimeter values, the drug allergy test was considered negative. Results: Twenty-two patients were included in the study. Twenty-one of the patients were female and one was male. Iron deficiency anemia was found in nine patients, and low iron stores in thirteen patients without anemia were found. Type 1 hypersensitivity reaction developed with Iron 3 Carboxymaltose in 7 patients, Iron 2 Sulfate in 5 patients, Iron 2 Glycine in 4 patients, Iron 3 Hydroxy Polymaltose in 4 patients, Iron 2 Fumarate in 1 patient and Iron 3 Hydroxide Sucrose in 1 patient. Allergy tests with all alternative iron drugs containing additional additives were negative. Conclusion: If patients with allergic reactions cannot be referred to allergy clinics, we think that oral iron salts with different additives can be used after the first dose is given in the hospital under general anaphylaxis precautions. We show that oral iron salts containing different additives can be safely used.

Effect of intravenous iron on endogenous erythropoietin and FGF-23 secretion in patients with chronic kidney disease

Introduction It has been observed that intravenous iron administration may suppress endogenous production of erythropoietin (EPO). We postulate that this effect may be mediated by increased FGF-23 secretion. Aim of the study To evaluate the short-term effect of intravenous iron sucrose administration on endogenous EPO secretion in patients with chronic kidney disease (CKD). Materials and methods The cohort comprised 35 nondialysis patients with CKD stages 3–5. All received 100 mg of intravenous iron (III)-hydroxide sucrose complex daily for five consecutive days. Plasma EPO, iFGF-23, cFGF-23, PTH, bone alkaline phosphatase (BAP), phosphorus (PO4), calcium (Ca), and high-sensitive C-reactive protein (CRP) were measured before, and two hours after, the first and third iron infusions, and after completing iron therapy. Results EPO concentration at the end of iron treatment was significantly lower than two hours after the first iron infusion (p = 0.0003) and before the third dose (p = 0.0006) (12.6 [10.2, 41.4] mIU/mL. vs. 30.9 [15.9, 54.2] mIU/mL and 33.4 [15.4, 56.7] mIU/mL, respectively). Conversely, plasma iFGF-23 was significantly higher before the third dose (61.1 [18.6, 420.1 4] pg/mL; p = 0.025) and after the course of treatment (92.1 [28.4, 878.1] pg/mL; p = 0.004) compared to pretreatment value (48.4 [16.2, 420] pg/mL). cFGF-23 concentration was significantly lower than baseline after the first iron dose (491.8 [257.7, 1086.3] vs. 339.2 [75.4, 951.2] RU/mL; p = 0.005) and after treatment (398.7 [90.4, 1022.3] RU/mL; p = 0.025). No significant linear correlation was found between changes in plasma EPO and FGF-23. Conclusions Although intravenous iron therapy causes parallel increase of FGF-23 and supression of endogenous EPO, these two effects seem to be independent.

ЭФФЕКТИВНОСТЬ ВНУТРИВЕННОГО ВВЕДЕНИЯ ЖЕЛЕЗА (III) ГИДРОКСИД САХАРОЗНОГО КОМПЛЕКСА У ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ С СОХРАНЕННОЙ ФРАКЦИЕЙ ВЫБРОСА И ДЕФИЦИТОМ ЖЕЛЕЗА

Abstract. Introduction. Iron deficiency is diagnosed in 59% of patients with chronic heart failure with preserved ejection fraction. The efficacy of iron therapy in these patients has not been studied. Aim. The purpose of the study is to study the effectiveness of intravenous administration of iron (III) hydroxide sucrose complex in patients with chronic heart failure with preserved ejection fraction and iron deficiency. Material and methods. A study was conducted on 55 patients with ischemic heart disease and/or hypertension complicated by chronic heart failure with preserved ejection fraction with iron deficiency (14 men and 41 women), mean age 71.88±6.90 years. Patients of the main group (30 people) in addition to traditional therapy received iron (III) hydroxide-sucrose complex, patients of the control group (25 people) received only traditional therapy. In all patients, functional activity, the severity of clinical manifestations, asthenia, anxiety, depression, quality of life were assessed, echocardioscopy, complete blood count, and iron metabolism were determined. All examinations in the main and control groups were performed before the start of the study, after 2 weeks of therapy, 2 and 6 months after the end of treatment. Statistical analysis of the results at different observation times was performed using Stata/MP version 14.0 and MedCalc Statistical Software version 18.2.1. Results and discussion. The inclusion of iron (III) hydroxide sucrose complex in the complex therapy of iron-deficient patients with chronic heart failure with preserved ejection fraction increases the level of iron, ferritin, hemoglobin and transferrin iron saturation and reduces clinical manifestations of heart failure, severity of asthenia, anxiety, depression and increases physical performance and quality of life. The positive effect of the iron preparation appears by the end of the course of treatment, reaches a maximum after 2 months and lasts for 6 months. Conclusion. To increase the effectiveness of the treatment of patients with chronic heart failure with preserved ejection fraction and iron deficiency, it is recommended to conduct complex therapy, including, in addition to traditional treatment the administration of iron (III) sucrose hydroxide complex.

Which part of the blood in the knee joint is responsible for its detrimental effects? (An experimental study on the knee joint in rabbits).

This study aims to determine the potential causative elements which are responsible for the cartilage damage in case of frequent intra-articular bleeding and to evaluate the effects of intra-articular free iron and chelation of iron in the knee joint. Thirty-five New Zealand rabbits were randomly divided into five groups according to substances injected into their knee joints. Plasma (group I) and cellular components (group II) of the blood harvested from the rabbits, iron (ferric hydroxide sucrose) (group III), iron&chelator (group IV) and only chelator (deferoxamine mesylate) (group V) were injected into their right knees three times a week for 12 weeks. The joint surface was examined histologically according to the classification system modified from Colombo etal. The changes in the synovial tissue were evaluated according to the scoring system modified from Madhok etal. Cartilage and synovial abnormality scores were significantly higher in all study groups when compared to their own controls (p < 0.0001). Cartilage scores of groups I and V were significantly lower when compared to groups III and IV (p = 0.002 for group I and p = 0.003 for group V). Synovial abnormality score of group I was significantly lower than scores of groups III and IV (p = 0.001); and of group V lower than groups III and IV (p = 0.003 and p = 0.001, respectively). All substances tested in this study caused a certain amount of damage in the cartilage tissue and led to synovial abnormalities. Both iron and iron&chelator caused more damage in the cartilage and led to more advanced synovial changes when compared to the plasma component of blood and chelator itself. Influence of iron and iron&chelators were found to be similar showing that chelation was inadequate in antagonizing the detrimental effects of iron.

EFFECT OF IRON DEFICIENCY CORRECTION ON HEART FAILURE PATIENT’S OUTCOMES

The aim of our study was to investigate the effect of intravenous and oral iron treatment on clinical parameters in Hart failure (HF) patients with iron deficiency (ID). We studied 78 adult patients with HF admitted to the hospital. All patients underwent a standardized clinical evaluation. Blood samples were obtained for: full blood count, serum iron concentration, ferritin, creatinine, and eGFR. Assessment of exercise capacity was performed by a 6-min walk test (6-MWT). Quality of life was studied using the Minnesota Quality of Life Questionnaire. Patients were divided in to two groups:&nbsp; 50 patients (group 1) received IV Ferrous (III) hydroxide sucrose complex (Venofer) 5ml/100mg; 28 patients (group 2) – controlled group. Treatment duration was 7.8±0.4 days in hospital. After discharge from the clinic, patients continued treatment with oral iron for 3 months. After 3 months patients were assessed again. In our study, iron treatment has been shown to improve clinically significant anemia and NYHA functional class. It also improved renal function and levels of NT-proBNP, but differences between two groups were not clinically significant. 6-minute walking distance test and quality of life were significantly improved in the iron treatment group. A heart failure iron treatment service can be set up as an independent or as an integrated service within heart failure care. All patients with HF should be routinely tested for serum iron and serum ferritin concentrations in addition to the usual blood tests. Intravenous Iron treatment is safe and can be used in hospital treatment in unstable and symptomatic patients. Oral Iron treatment can be used for long-term outpatient treatment.

A Strategy of "Resistance Blood Management" in Pregnant Women at Risk of Massive Obstetric Hemorrhage

The purpose of the study: To determine the effectiveness of treatment of anemia with intravenous iron (III) hydroxide sucrose complex (Sufer) in pregnant women with pathological placentation, as the first stage of "patient blood management" before delivery. Our studies have been limited to examining the effectiveness of an iron supplement for the treatment of anemia. Methods: Among 86 pregnant women with placental pathology, 58 (70.7%) had anemia. Severe anemia with a hemoglobin level &lt;70 g/l was in 13 (22.4%), and moderate anemia with a hemoglobin level &lt;90 g/l - in 19 (32.8%). The first group included 18 (31.1%), pregnant women, with placenta previa with periodic blood loss during pregnancy. The second group consisted of 40 (68.9%) pregnant women with the invasive placenta. The gestation period in all women was 33 + 6 weeks. Anemia was treated by administering intravenous iron Sufer 3 times a week (5-7 injections). Results: The main factor that led to pathological placentation was the scar on the uterus. In pregnant women of the second group with invasive placenta, the scar on the uterus was in 38 (95%) women. Severe anemia was present in 2 (11.1%) pregnant women with placenta previa and 2.4 times more often in pregnant women with invasive placenta -11 (27.5%). Moderate anemia was present in 4 (22.2%) women in the first group and in 15(37.5%) in the second group. In pregnant women with severe anemia, after 5-7 injections of the drug Sufer significantly increased the level of hemoglobin by 30 g/l, increased the number of erythrocytes to 2.8x1012/l, increased serum iron by 2 times, the level of ferritin increased to 19.6 μg/l and decreased transferrin content. For pregnant women with moderate anemia, 3-5 injections of the drug were sufficient to normalize the indicators. Normalization of blood parameters allowed to reduce the risk of bleeding, and the number of blood transfusions and improved treatment outcomes. Conclusion: Timely diagnosis of iron deficiency anemia in pregnant women with placental pathology is an important means of preventing massive blood loss and reducing the number of blood transfusions, as the first stage of the strategy "patient blood management". Intravenous iron (III) sucrose complex hydroxide (Sufer) has shown high clinical efficacy in the treatment of iron deficiency anemia in pregnant women with placental pathology and can be recommended for widespread use in practical medicine.

Possibilities of Correcting Iron Deficiency Anemia Caused by Chronic Kidney Disease Complicated by Chronic Heart Failure

Abstract: The study evaluated the effectiveness of intravenous administration of iron saccharate (Sufer® preparation) for 2 weeks in 12 patients with iron deficiency anemia due to chronic kidney disease, who were examined and treated in the nephrology department of the Dnepropetrovsk Regional Clinical Hospital named after I.I. Mechnikov. Inclusion of iron (III) hydroxide sucrose complex into therapy led to a significant increase in hemoglobin, ferritin, iron in blood plasma, and contributed to a decrease in creatinine levels (p&lt;0.01). The increase in hemoglobin level began already from the 5th day of treatment. After 2 weeks, the hemoglobin level increased by 13% (p&lt;0.01). When using the drug, there were no significant side effects that required a change in its daily dose or discontinuation of treatment. The therapeutic effect and good tolerance of iron (III) sucrose complex hydroxide allow us to recommend it as the drug of choice for iron deficiency anemia in patients with chronic kidney disease. Keywords: chronic kidney disease, iron deficiency anemia, iron saccharate, Sufer®.

Pathogenetic role of tumor necrosis factor (TNF-α) for the development of peritoneal tuberculosis in an experiment

Currently tuberculosis is considered as a group of diseases united by one etiological factor. The pathogenesis of certain localizations of tuberculous inflammation, in particular peritoneum tuberculosis, hasn’t been sufficiently studied. The role of cytokine mechanisms in the development of the disease and the elaboration of non-sterile immunity requires further experimental studies, in particular the creation of a reproducible model on laboratory animals.The aim: to study the effect of TNF-α on the development of tuberculosis of the serous coat of the abdominal cavity, as well as to evaluate the possibility of modeling tuberculous peritonitis in laboratory animals using infliximab.Materials and methods. The studies were conducted on 18 male rabbits, which were simulated peritoneal tuberculosis by intra-abdominal administration of a suspension of Mycobacterium tuberculosis. 10 rabbits of the experimental group were intravenously injected with an infliximab solution and an iron (III) hydroxide sucrose complex intraperitoneally a day before infection.Results. In the control group of animals, tuberculosis either didn’t develop, or in a third of cases it affected only the pulmonary parenchyma, while proliferative processes prevailed. On the contrary, in animals with inactivated TNF-α, in 100 % of observations, tuberculous peritonitis was detected with associated lung damage and the predominance of alterative caseous processes.Conclusion. The created model of tuberculous peritonitis shows the leading role of TNF-α in the activation of macrophages, as well as in attracting cells to the site of infection. This is the primary signal necessary for the formation and stability of granulomas since the neutralization of this cytokine leads to a loss of control over the infection and the destruction of the granuloma with the development of destructive tuberculosis in the serous coat of the abdominal cavity.

Global Research Expedition on Altitude-related Chronic Health 2018 Iron Infusion at High Altitude Reduces Hypoxic Pulmonary Vasoconstriction Equally in Both Lowlanders and Healthy Andean Highlanders

Increasing iron bioavailability attenuates hypoxic pulmonary vasoconstriction in both lowlanders and Sherpas at high altitude. In contrast, the pulmonary vasculature of Andean individuals with chronic mountain sickness (CMS) is resistant to iron administration. Although pulmonary vascular remodeling and hypertension are characteristic features of CMS, the effect of iron administration in healthy Andean individuals, to our knowledge, has not been investigated. If theinterplay between iron status and pulmonary vascular tone in healthy Andean individuals remains intact, this could provide valuable clinical insight into the role of iron regulation at high altitude. Is the pulmonary vasculature in healthy Andean individuals responsive to iron infusion? In a double-blinded, block-randomized design, 24 healthy high-altitude Andean individuals and 22 partially acclimatized lowlanders at 4,300m (Cerro de Pasco, Peru) received an IV infusion of either 200mg of iron (III)-hydroxide sucrose or saline. Markers of iron status were collected at baseline and 4h after infusion. Echocardiography was performed in participants during room air breathing (partial pressure of inspired oxygen [Pio2] of approximately 96mmHg) and during exaggerated hypoxia (Pio2 of approximately 73mmHg) at baseline and at 2 and 4h after the infusion. Iron infusion reduced pulmonary artery systolic pressure (PASP) by approximately 2.5mmHg in room air (main effect, P< .001) and by approximately 7mmHg during exaggerated hypoxia (main effect, P< .001) in both lowlanders and healthy Andean highlanders. There was no change in PASP after the infusion of saline. Iron metrics were comparable between groups, except for serum ferritin, which was 1.8-fold higher at baseline in the Andean individuals than in the lowlanders (95%CI, 74-121ng/mL vs37-70ng/mL, respectively; P= .003). The pulmonary vasculature of healthy Andean individuals and lowlanders remains sensitive to iron infusion, and this response seems to differ from the pathologic characteristics of CMS.

Особенности патогенетических механизмов туберкулезного перитонита в эксперименте

The prevalence of tuberculous peritonitis that has been observed in the recent decades is the result of lymphohematogenous spread of Mycobacterium tuberculosis (MBT) from lungs and other extrapulmonary sources. It is still unclear why certain organs and anatomical regions get involved in the inflammatory process during generalization of the tuberculosis infection. Why do some cases develop into peritoneal tuberculosis and other into kidney tuberculosis? Thus study aimed to investigate the pathogenesis of tuberculous peritonitis in a reproducible biological model. Tuberculous peritonitis was modeled in 18 rabbits (10 in the test group, 8 in control) by intraperitoneal inoculation of the MBT suspension. In order to suppress peritoneal macrophages and major cytokines, test group rabbits were injected with the TNFα inhibitor and iron (III) hydroxide sucrose complex before being infected, while control group rabbits received no immunosuppressive drugs. Autopsy of the control group animals revealed changes characteristic of pulmonary tuberculosis in 37.5% of cases, with no damage to other organs and systems registered. Conversely, test group rabbits had the signs of tuberculous peritonitis in their abdominal cavities. The results of this study suggest that it is the local immunity of an anatomical area that largely determines whether a secondary focus of extrapulmonary tuberculosis infection will develop there or not. For the peritoneum, a smaller pool of peritoneal macrophages and weaker cytokine production is a necessary and sufficient condition to have tuberculous peritonitis developing therein.

Patient blood management» strategy in pregnant women with the risk of massive obstetric bleeding

The objective: a determination of the effectiveness of anemia treatment with intravenous iron (III) hydroxide sucrose complex in pregnant women with pathological placentation, as the first stage of “patient blood management” before delivery.Materials and methods. Among 86 pregnant women with placental pathology, 58 (70.7 %) had anemia. Severe anemia with a hemoglobin level &lt;70 g/l was in 13 (22.4 %), moderate anemia with a hemoglobin level &lt;90 g/l — in 19 (32.8 %). The first group included 18 (31.1 %) pregnant women with placenta previa with periodic blood loss during pregnancy. The second group consisted of 40 (68.9 %) pregnant women with invasive placenta. The gestation period in all women was 33+6 weeks. Anemia was treated by intravenous administering iron (III) hydroxide sucrose complex 3 times a week (5-7 injections).Results. The main factor that led to pathological placentation was the scar on the uterus. In pregnant women in the second group with invasive placenta, the scar on the uterus was in 38 (95 %) women. Severe anemia was present in 2 (11.1 %) pregnant women with placenta previa that was in 2.4 times less than in pregnant women with invasive placenta — 11 (27.5 %). Moderate anemia was present in 4 (22.2 %) women in the first group and in 15 (37.5 %) in the second group.In pregnant women with severe anemia, after 5–7 injections of the drug iron (III) hydroxide sucrose complex the level of hemoglobin increased significantly by 30 g/l, the number of erythrocytes increased to 2.8×1012/l, serum iron – in 2 times, the level of ferritin – to 19.6 μg/l and transferrin content decreased. For pregnant women with moderate anemia, 3–5 injections of the drug were sufficient to normalize the indicators. Normalization of blood parameters allowed to reduce the risk of bleeding, the number of blood transfusions and improve treatment outcomes.Conclusions. Timely diagnosis of the iron deficiency anemia in pregnant women with placental pathology is an important means of preventing massive blood loss and reducing the number of blood transfusions, as the first stage of the strategy “patient blood management”.Intravenous iron (III) sucrose complex hydroxide has demonstrated a high clinical efficacy in the treatment of iron deficiency anemia in pregnant women with placental pathology and can be recommended for widespread use in practical medicine.

Influence of iron manipulation on hypoxic pulmonary vasoconstriction and pulmonary reactivity during ascent and acclimatization to 5050m.

Iron acts as a cofactor in the stabilization of the hypoxic-inducible factor family, and plays an influential role in the modulation of hypoxic pulmonary vasoconstriction. It is uncertain whether iron regulation is altered in lowlanders during either (1) ascent to high altitude, or (2) following partial acclimatization, when compared to high-altitude adapted Sherpa. During ascent to 5050m, the rise in pulmonary artery systolic pressure (PASP) was blunted in Sherpa, compared to lowlanders; however, upon arrival to 5050m, PASP levels were comparable in both groups, but the reduction in iron bioavailability was more prevalent in lowlanders compared to Sherpa. Following partial acclimatization to 5050m, there were differential influences of iron status manipulation (via iron infusion or chelation) at rest and during exercise between lowlanders and Sherpa on the pulmonary vasculature. To examine the adaptational role of iron bioavailability on the pulmonary vascular responses to acute and chronic hypobaric hypoxia, the haematological and cardiopulmonary profile of lowlanders and Sherpa were determined during: (1) a 9-day ascent to 5050m (20 lowlanders; 12 Sherpa), and (2) following partial acclimatization (11±4days) to 5050m (18 lowlanders; 20 Sherpa), where both groups received an i.v. infusion of either iron (iron (iii)-hydroxide sucrose) or an iron chelator (desferrioxamine). During ascent, there were reductions in iron status in both lowlanders and Sherpa; however, Sherpa appeared to demonstrate a more efficient capacity to mobilize stored iron, compared to lowlanders, when expressed as a Δhepcidin per unit change in either body iron or the soluble transferrin receptor index, between 3400-5050m (P=0.016 and P=0.029, respectively). The rise in pulmonary artery systolic pressure (PASP) was blunted in Sherpa, compared to lowlanders during ascent; however, PASP was comparable in both groups upon arrival to 5050m. Following partial acclimatization, despite Sherpa demonstrating a blunted hypoxic ventilatory response and greater resting hypoxaemia, they had similar hypoxic pulmonary vasoconstriction when compared to lowlanders at rest. Iron-infusion attenuated PASP in both groups at rest (P=0.005), while chelation did not exaggerate PASP in either group at rest or during exaggerated hypoxaemia ( =67mmHg). During exercise at 25% peak wattage, PASP was only consistently elevated in Sherpa, which persisted following both iron infusion or chelation. These findings provide new evidence on the complex interplay of iron regulation on pulmonary vascular regulation during acclimatization and adaptation to high altitude.

P0860INTRAVENOUS IRON ADMINISTRATION SUPPRESSES ENDOGENOUS ERYTHROPOIETIN SECRETION IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Abstract Background and Aims Iron therapy may induce inflammatory response that may indirectly affect endogenous erythropoietin (EPO) production. We postulated that increased secretion of FGF-23 may provide a link between intravenous iron administration and suppression of endogenous EPO secretion. Evaluation of a short-term effect of intravenous iron sucrose administration on the secretion of endogenous EPO in patients with chronic kidney disease (CKD). Method 35 non-dialysed patients with G3b-5 CKD were included. All patients received 100 mg of intravenous iron infusion (iron (III)-hydroxide sucrose complex) daily for 5 days. Plasma concentration of EPO, iFGF-23, cFGF-23, PTH, bone alkaline phosphatase (BAP), phosphorus (PO4) and calcium (Ca) were measured before and two hours after the first and third iron infusion and at the end of iron therapy. Results EPO concentration at the end of iron treatment was significantly lower compared to 2 h after the first iron infusion (p&amp;lt;0.001) and before the third dose (p&amp;lt;0.001) (12.6 [31.2] mIU/mL, 30.9 [38.3] mIU/mL, 33.4 [41.3] mIU/mL and, respectively). Conversely, serum iFGF-23 increased significantly after the third dose (61.1 [401.5] pg/mL; p&amp;lt;0.05) and after the treatment (92.1 [849.7] pg/mL; p&amp;lt;0.01) compared to pre-treatment value (48.4 [403.8] pg/mL). cFGF-23 concentration decreased significantly after the first dose of iron (491.8 [828.6] vs. 339.2 [875.8] RU/mL; p&amp;lt;0.01) and after the completion of the therapy (398.7 [931.9]) vs. baseline (p&amp;lt;0.05). There was no linear correlation between EPO and FGF-23. Conclusion Intravenous iron therapy increases the secretion of FGF-23 and supresses endogenous EPO production but these two effects do not seem to be related.

Usefulness of mid-week hemoglobin measurement for anemia management in patients undergoing hemodialysis: a retrospective cohort study

BackgroundShort-term hemoglobin (Hb) variability related to volume status is observed in chronic kidney disease (CKD) patients receiving hemodialysis (HD). Given the lack of studies regarding outcomes according to the day of Hb sampling, the existing guidelines do not strongly recommend regarding measurement timing. Pre-dialysis mid-week sampling (Wednesday and Thursday) is preferable to minimize short-term Hb variability, although numerous HD centers perform early-week sampling (Monday and Tuesday). The different measurement days may influence the prescribed dose of erythropoiesis-stimulating agent (ESA) and related patient outcomes. We investigated changes in Hb levels and ESA doses according to the Hb measurement day among HD patients.MethodsStarting September 2013, the day for pre-dialysis Hb measurement at the Asan Medical Center was changed from early-week days to mid-week days. This single-center retrospective study evaluated medical records of 92 patients who received maintenance HD between September 2012 and August 2014.ResultsThere was no significant difference in the mean Hb levels between early-week days and mid-week days (10.71 ± 0.06 g/dL vs. 10.78 ± 0.47 g/dL, p = 0.105). However, the mean doses of darbepoetin-α on early-week days were higher than those on mid-week days (175.4 ± 72.5 μg/month vs. 163.7 ± 83.6 μg/month, p = 0.022). The mean doses of intravenous iron hydroxide sucrose for early-week measurements were also higher than those for mid-week measurements (623.0 ± 489.0 mg/year vs. 447.0 ± 505.2 mg/year, p = 0.001). The mean interdialytic weight gains were 2.81 ± 0.82 kg on early-week days and 1.99 ± 0.61 kg on mid-week days (p < 0.001).ConclusionsCompared with early-week measurements, mid-week pre-dialysis Hb measurements were significantly associated with lower ESA doses without a change in Hb levels.

Selection of Optimal Therapy at Correction of the Anemic Syndrome in Patients With Chronic Heart Failure

to study efficacy of various schemes of therapy of patients with chronic heart failure (CHF) and anemia. We included in this study 208 patients with CHF of ishemic etiology (mean age 60.6±1.4 years, 174 with and 34 without anemia). According to therapeutic regimen of the use of methoxy polyethylene glycol-epoetin beta (MEB, 0.60 mсg/kg) and intravenous (IV) iron hydroxide sucrose complex all patients were divided into 4 groups. In all patients before and after treatment we determined Hb, Ht, plasma levels of ferritin, erythropoietin (EPO), NT-proBNP, IL-1, IL-6, TNF-α, transferrin saturation (TS), total vascular peripheral resistance, and parameters of systolic and diastolic function of left ventricular (LV) myocardium (by echocardiography and doppler echocardiography). In patients with NYHA class I-IV CHF and anemia increases of Hb, Ht, TS, levels of EPO and ferritin occurred during treatment by basic drugs combained with MEB. In subgroups of patients with NYHA class I-II and III-IV the 6-minute walk distance significantly increased by 25.1 and 38.3%, and GFR- by 24.5 and 14.9%, respectively. At the background of therapy with IV iron we observed significant increases of Hb, plasma level of ferritin, and TS. Combined treatment with MEB and IV iron was associated with positive dynamics of Hb, Ht, levels of ferritin, EPO, NT-proBNP, and IL-6. In this group in subgroups of patients with NYHA class I-II and III-IV the 6-minute walk distance significantly increased by 21.6 (p.

Correction of anemic syndrome in patients with chronic heart failure with intravenous iron-containing complex

Aim. To evaluate efficacy of intravenous iron (III) hydroxide sucrose complex for anemic sydrome correction in patients with chronic heart failure and anemia. &#x0D; Methods. 126 patients with chronic heart failure of ischemic etiology of I-IV NYHA functional class were examined, 92 of them were diagnosed with anemia. The average age of patients was 60.6±1.4 years. All patients were randomized into 2 groups. Group 1 included 49 patients with chronic heart failure and anemia who received only basic therapy, including angiotensin converting enzyme inhibitors, β-blockers, diuretics, digoxin, and nitrates. Group 2 included 43 patients with chronic heart failure, anemia and iron deficiency who received combination therapy with intravenous iron (III) hydroxide sucrose complex (Venofer) and basic therapy. In all patients on the treatment levels of hemoglobin, ferritin, transferrin saturation, erythropoietin, N terminal pro brain natriuretic peptide, interleukin 1, interleukin 6, tumor necrosis factor α in plasma, parameters of systolic and diastolic function of the left ventricle myocardium by echocardiography and doppler echocardiography were evaluated dynamically. &#x0D; Results. In patients with chronic heart failure of I-IV NYHA class and anemia (group 1) on the background of basic therapy, no positive dynamics was registered for levels of hemoglobin, hematocrit, ferritin, transferrin saturation, erythropoietin, N terminal pro brain natriuretic peptide, interleukin 1, interleukin 6, and tumor necrosis factor α. In group 2 during therapy there was a significant increase of the level of hemoglobin, plasma ferritin and transferrin saturation. &#x0D; Conclusion. Patients with chronic heart failure of I-IV NYHA functional class, anemia, iron deficiency and normoerythropoietinaemia or hypererythropoietinaemia, administration of intravenous iron (III) hydroxide sucrose complex (Venofer) with basic therapy is recommended.

PREVENTION OF POSTOPERATIVE ANEMIA IN PATIENTS WITH TUBERCULOSIS

The study included 28 patients with pulmonary tuberculosis and a possible postoperative hemoglobin level of less than 120 g/l. For the prevention of postoperative anemia it is used recombinant human erythropoietin alpha and iron (III) hydroxide sucrose complex. Hemoglobin levels were monitored for 4 weeks after surgery and it is estimated the need for blood transfusions. Use of recombinant human erythropoietin and iron sucrose in patients with pulmonary tuberculosis increases basic hematological parameters as compared with the control group, and reduces the risk of postoperative anemia.

Clinical and biochemical improvement following low‐dose intravenous iron therapy in a patient with erythropoietic protoporphyria

Clinical and biochemical improvement following low‐dose intravenous iron therapy in a patient with erythropoietic protoporphyria

GRP-128 Parenteral Iron: French Pharmacistsí Choices For Preventing Iatrogenic Events

BackgroundFerric carboxymaltose (FCM) (Ferinject) is a new parenteral iron used to treat iron deficiency anaemia. Infusion modalities are different from ferric hydroxide sucrose complex (FHSC), formerly used in our hospital...