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INTRAVENÖZ DEMÎR TEDAVİSİNİN OKSİDAN STRES VE ERİTROSİTLERİN BİÇİM DEĞİŞTİREBİLME YETENEĞİ ÜZERİNE ETKİSİ

THE EFFECTS OF INTRAVENOUS IRON TREATMENT ON OXIDANT STRESS AND ERYTHROCYTE DEFORMABILITY IN HEMODIALYSIS PATIENTS

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2001

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Abstract (2. Language): 
Intravenous iron supleınentation is one of the important components of anemia threatment. Oxidant properties of free iron is well known, however data concerning effects of intravenous (IV) iron in hemodialysis (HD) patients on oxidant stress and erythrocyte deformability (EDEF), a measure of it, are conflicting. In the present study we aimed to evaluate the effects of I. V iron on oxidant stress and EDEF. Thirteen HD patients (10 males, 3 females, mean age: 49,92+13,41 years), administered iron intravenously, were enrolled into the study. All patient were underwent dialysis thrice, first without iron supplementation, 2 second with 20 mg iron supplementation and the last 100 mg iron supplementation. Iron HI hydroxide sucrose (Venofer®) was the medication used. In study periods, 7 blood samples were drawn from each patient: before dialysis, at the end of the dialysis, 15, 30, 60, 90 and 120 minutes after the in all three session with an exception that 15th minutes samples were not drawn in the session when 100 mg iron was administered since iron was given by infusion during the first 30 minutes of the 3rd HD session. As markers of oxidant stress EDEF and malondialdehyde (MDA) were studied in all samples. When the results of the session without iron were considered, bivariate correlatioan analysis did not reveal any correlation between MDA and EDEF. When the course of each parameter were considered seperately, plasma MDA levels 90 and 120 minutes after HD session were significantly higher than that of the before and just after the HD session (p<0.05). Whereas EDEF in 60, 90and 120 minutes after HD session was found to be worsened when compared to before and just after HD sessions' values (p<0.05). When results of the session with 20 mg iron were considered, EDEF and MDA values were not found to be correlated and throughout the course, EDEF did not present any significant change whereas MDA levels 60, 90 and 120 minutes after HD session werefound to be significantly higher than that of the 15 and 30 minutes after HD session (p<0.05). When results of the session with 100 mg iron were considered, MDA levels 30, 60, 90 and 120 minutes after HD session were found to be significantly higher than that of the before and just after the HD sessions' (p<0,05). EDEF in 120 minutes after HD session was increased. As a conclusion, in the present study, it was observed that intravenously administered iron in 20 and 100 mg doses did not cause additional deteriorating effect on oxidant stress however EDEF may be ameliorated by I. Viron
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Abstract (Original Language): 
Hemodiyaliz (HD) hastalarında intravenöz (I. V.) yolla demir desteği anemi tedavisinin önemli öğelerindendir. Serbest demirin oksidan stresi artırıcı etkisi olduğu bilinmektedir. Bununla beraber HD hastalarına verilen demirin oksidan stres ve bunun bir göstergesi olan eritrositlerin biçim değiştirebilme yeteneği (EBDY) üzerine olan etkileri çelişkilidir. Bu çalışmanın amacı HD hastalarına verilen t. V. demirin farklı dozlarda oksidan stres ve EBDY üzerine etkisini araştırmaktır. Çalışmaya idame demir tedavisi alan 13 kronik HD (10 erkek - 3 kadın;yaş 49,92±13.4yıl) hastası alınmıştır. Birinci HD seansında hastalara 1. V. demir verilmemiştir; bunu izleyen HD seansında ise tüm hastalara HD seansı sonunda 20 mg demir [Demir IIIhidroksit sııkroz - Venofer® ] t. V. bolus tarzında verilmiştir. Üçüncü HÛ seansında ise 100 mg demir 30 dk.da infüzyonla verilmiştir. İlk iki seans sırasında tüm hastalardan diyaliz öncesi, diyaliz sonrası, diyalizden 15, 30, 60, 90 ve 120 dakika sonra olmak üzere toplam 7 örnek alınmıştır. 1. V demirin 30 dakika infüzyonla verildiği üçüncü seansta ise 15. dakikada örnek alınmamıştır. EBDY ve oksidan stresin göstergesi olan plazma malondialdehid (MDA) düzeyi her üç seansta tüm örneklerde çalışılmıştır. Demir verilmeyen seans sonuçları değerlendirildiğinde HD sonrası 90. dk ve 120. dk MDA değerlerinin HD öncesi ve sonrası değerlerine göre anlamlı olarak yükseldiği (p<0.05); 60. dk, 90. dk ve 120. dk EBDY'nin ise HD öncesi ve sonrası değerlerine göre anlamlı olarak bozulduğu saptanmıştır (p<0.05). 20 mg demir verilen seans sonuçları incelendiğinde ise EBDY değerleri arasında fark saptanmazken; 60. dk, 90. dk ve 120. dk MDA değerlerinin 15. ve 30. dk'ya göre istatistiksel olarak anlamlı olacak şekilde arttığı gözlenmiştir (p<0.05). 100 mg demir verilen seansta ise 30., 60., 90. ve 120. dk. MDA değerlerinin HD öncesi ve sonrasına göre anlamlı olarak yükseldiği (p<0.05); 90. ve 120. dk EBDY'nin ise HD öncesi ve sonrası değerlerine göre daha iyi olduğu saptanmıştır (p<0.05). EBDY ve MDA değerleri arasında ise korelasyon bulunmamıştır. Özet olarak bu çalışma ile HD hastalarında İ. V. olarak verilen 20 ve 100 mg demirin oksidan stres üzerine olumsuz ek bir etki oluşturmadığı ve ayrıca EBDY'yi ise olumlu etkileyebildiği sonucuna varılmıştır.
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