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Kronik Böbrek Hastalarında İntravenöz Demir Tedavisi, Oksidatif Stres ve N-asetilsistein’in Etkisi

Intravenous Iron Treatment in Patients with Chronic Renal Disease, Oxidative Stress and the Effect of N-acetylcysteine

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2011
DOI: 
DOI 10.5262/tndt.2011.1001.11

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
AIM : One of the problems in treating anemia of CRD is iron deficiency, and intravenous (IV) iron supplementation has become an accepted therapy of iron deficiency in CRD patients. However, it is known that free iron is prooxidant and causes oxidative stress by generation of hydroxyl radicals through the fenton reaction.The purpose of this study was to determine the relationship between IV iron treatment and oxidative stress, and to determine the effect of N-acetylcysteine (NAC), which is an antioxidant, on this possible oxidative stress. MA TERIAL and M ETHOD: 30 patients with iron deficiency anemia and CRD (stage3-5 according to K/DOQI) scheduled to receive IV iron treatment were separated into two groups. One group received only IV iron, and the other group received NAC orally beside IV iron treatment. Malondialdehyde (MDA), glutathione peroxidase (GPx),catalase (CAT) and superoxide dismutase (SOD) levels were measured to determine oxidative stress in each group. RESUL TS: The antioxidant enzyme levels of erythrocyte Glutathion peroxidase (GPx) and catalase (CAT) decreased significantly but erythrocyte superoxide dismutase (SOD) activity did not change in the IV iron treatment group. The decrease in CAT levels was prevented with NAC pre-treatment but GPx levels decreased significantly and SOD levels also did not change from the baseline. CONCLU SION: Our study shows that IV iron therapy in CRD changes some oxidative stress parameters.600 mg/d NAC pre-treatment dose not increase the antioxidant effect of IV iron therapy significantly.
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Abstract (Original Language): 
AMA Ç: Kronik Böbrek Hastalığında (KBH) anemi tedavisinde görülen önemli bir sorun da demir eksikliğidir ve IV demir replasmanı bu amaçla sık kullanılmaktadır. Ancak, serbest demirin prooksidan olduğu ve fenton reaksiyonu yoluyla hidroksil radikalleri oluşturarak oksidatif strese (OS) ve endotel disfonksiyonuna (ED) sebep olduğu ileri sürülmektedir. Bu çalışmanın amacı, IV demir tedavisi ile OS arasındaki ilişkiyi ve bir antioksidan olan N-asetilsistein (NAC)’in oluşabilecek bu OS üzerine etkisini değerlendirmektir. GEREÇ ve YÖN TEM: K/DOQI rehberi kriterlerine göre Evre 3-5 KBH tanısı konulan ve anemi saptanan 30 hasta çalışmaya alınmıştır. Demir eksikliği nedeniyle IV demir verilmesi planlanan hastalar iki gruba ayrılmış, bir gruba yalnızca parenteral demir verilirken, diğer gruba parenteral demirin yanısıra NAC de verilmiştir. Her iki grupta da oksidatif stresi değerlendirmek amacı ile malondialdehit (MDA), glutatyon peroksidaz (GPx), katalaz (CAT) ve süperoksit dismutaz (SOD) düzeyleri incelenmiştir. BUL GULA R: Çalışmamızda parenteral demir tedavisi alan grupta antioksidan savunma göstergeleri olan GPx ve CAT düzeylerinde azalma olurken SOD düzeylerinde değişiklik olmadı. Demir tedavisine NAC’in eklenmesi ile CAT düzeylerindeki azalmanın önüne geçilirken GPx düzeyindeki azalmanın önüne geçilememiştir. Ayrıca NAC tedavisi SOD düzeylerini ve MDA düzeylerini anlamlı düzeylerde değiştirmemiştir. SONU Ç: Kronik böbrek hastalarında IV demir tedavisi bazı oksidatif stres göstergelerinde değişikliğe yol açmaktadır. IV demir tedavisine eklenen 600 mg/gün NAC katalaz düzeyindeki azalmanın önüne geçse de belirgin antioksidan etki oluşturmamaktadır.
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  • Turkish

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