Elsevier

Kidney International

Volume 64, Issue 2, August 2003, Pages 728-736
Kidney International

Dialysis – Transplantation
High-dose parenteral iron sucrose depresses neutrophil intracellular killing capacity

https://doi.org/10.1046/j.1523-1755.2003.00125.xGet rights and content
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High-dose parenteral iron sucrose depresses neutrophil intracellular killing capacity.

Background

Iron is essential for the formation of hemoglobin. During long-term treatment with human recombinant erythropoietin (rhEPO), the majority of end-stage renal disease (ESRD) patients will not respond adequately to rhEPO unless substituted with intravenous iron. However, concern exists about possible detrimental effects of parenteral iron on cellular host defense and iron-mediated increments of oxidative stress.

Methods

We analyzed phagocytic functions of polymorphonuclear leukocytes (PMN) isolated from 20 ESRD patients on peritoneal dialysis in response to 300 mg of iron sucrose or placebo administered intravenously over two hours in a randomized, double-blind manner. We evaluated FcγR-dependent phagocytosis and killing (primary outcome variable) of opsonized Escherichia coli, FcγR-dependent oxidative burst capacity, and complement receptor 3 (CR3, Mac1, CD11b/CD18)/tumor necrosis factor alpha (TNFα)-mediated release of bactericidal lactoferrin before, during, one hour, and two days after administration.

Results

The absolute count and the percentage of E. coli killed by PMN of iron sucrose–treated peritoneal dialysis patients decreased significantly over time in comparison to placebo-treated patients (F = 3.48, df = 4, P = 0.008; F = 3.99, df = 4, P = 0.006, respectively). All secondary outcome variables were not different between both groups over time.

Conclusions

Killing capacity of PMN isolated from ESRD patients decreases in response to high-dose parenteral iron sucrose, possibly in part explaining reported higher hospitalization rates and lower survival rates of dialysis patients receiving frequent and high-dose parenteral iron.

Keywords

iron
chronic kidney failure
neutrophils
randomized controlled trial

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