Prospective Study On The Effects Of Intravenous Iron Injection And Oral Iron Administration On Renal Anemia And Their Related Oxidative Stress

Background: The effect of intravenous iron on renal anemia has been recognized generally, and the oxidative stress caused by intravenous iron has been aware of gradually. The application of low-dose intravenous iron injection to renal anemia becomes necessary, especially after it has been confirmed that administration of high-dose intravenous iron can result in oxidative stress .8-epi-prostaglandin F_2α (8-epi-PGF_2α), as one of isoprostanes of prostaglandins , can be synthesized in a free radical catalyzed manner from arachidonic acid through both cyclooxygenase and non-cyclolxygenase mechanism. 8-epi-prostaglandin F_2α is one of the biomarkers of lipid peroxidation in vivo, high concentration 8-epi-PGF_2α in plasma is accompanied by oxidative stress. 8-epi-prostaglandin F_2α in hemodialysis patients (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients are significantly elevated than that in healthy person, and 8-epi-prostaglandin F_2α in HD patients is significantly elevated than that in CAPD patients.Pregnancy-associated plasma protein A (PAPP-A), as a zinc-binding metalloproteinase, is insulin-like growth factor binding protein-4 (IGFBP-4) protease. PAPP-A is correlated with advanced oxidation protein products (AOPP) and C-reactive protein (CRP) in HD patients, indicates that serum PAPP-A can become a new biomarker of inflammation and oxidative stress in hemodialysis patients.The method of detecting serum PAPP-A and 8-epi-PGF_2α in evaluating the oxidative stress in hemodialysis patients has not been reporteddomestically.Objective: Through the prospective control study of intravenous iron injection and oral iron administration, their clinic effects are compared and the change of oxidative stress biomarker malondialdehyde(MDA), PAPP-A and 8-epi-PGF_2α are analyzed. The safety and the efficacy of low-dose intravenous iron administration on renal anemia are evaluated.Subjective and methods : 12 patients whose haematoglobin serum concentration were 60⁹9g/L(loading dose group, LDG) and 22 patients whose haematoglobin serum concentration were 100¹20g/L(sustaining group, SG) were enrolled in the s tudy. Each group were randomly divided into oral administration group and intravenous injection group. All the patients in LDG were administrated loading-dose iron firstly (the volumn iron dose based on the formula was injected fractionally, 100mg dextran-40 ferric hydroxide compound was intravenously dropped one hour before the end of per hemodialysis), the maintenance dose of iron was performed as follow: intravenously dropped 100mg dextran-40 ferric hydroxide compound per day in intravenous injection group; take orally polysaccharide-iron complex 300mg per day in oral administration group respectively; SG was administrated directly maintenance dose of iron that was similar as loading-dose group.Venous blood obtained from the LDG before and after loading dose iron (half month after having administrated loading-dose ) and after maintenance-dose three months was to detect blood routine test, serum iron related test ; Venous blood were also obtained from LDG before and when ( the time at the end of performing the last loading-dose iron), after loading dose and after maintenance-dose three months, which is to detect blood routine test, serum iron related test, 8-epi-PGF_2α, PAPP-A and MDA. The venous blood obtained from SG before administration and after manintenance-dose three months was to detect blood routine test, serum four iron, ferritin, 8-epi-PGF_2α, PAPP-A and MDA .Results: The quantity of haematoglobin, 8-epi-PGF_2α, PAPP-A and MDA after maintenance dose three months in intravenous iron injection group both loading-dose group and maintenance-dose group is elevated than oral administration group; The serum ferritin after maintenance-dose threemonths in maintenance group is elevated than oral administration group; The serum concentration of PAPP-A when loading-dose is end is positively correlated with the dose of loading-dose iron.Conclusions: .Intravenous iron administrating is more effective than oral reinforcing iron administration on renal anemia patients; Intravenous iron administration could cause oxidative stress; Oxidative stress caused by intravenous iron can be evaluated by detecting serum concentration of 8-epi-PGF_2α, PAPP-A and MDA; The dose of intravenous iron admini- stration is positively related with serum concentration of PAPP-A.