Effects Of Oral Iron And Intravenous Iron On Intestinal Microflora In Patients With MHD Detected By Next Generation

Objective:Chronic kidney disease is often complicated by anemia,which more often occurs in patients with end stage renal disease.Renal anemia is a risk factor for cardiovascular disease that has an adverse effect on patients’ quality of life and prognosis.These patients usually require iron replacement therapy.Recently,the theory of the gut-kidney axis has become increasingly important.The gut microorganisms of CKD patients were considerably altered,as previously reported.However,iron supplementation can also affect the gut microbiota.Therefore,we will contrast the influence of the gut microbiota between oral iron and intravenous iron in MHD patients to clarify the advantage of intravenous iron.Methods:We took feces samples from MHD patients before and after iron supplementation to investigate the effect of iron on gut microbiome and compare the effects of the two types of iron supplementation.Oral ferrous succinate tablets(n =14)or intravenous iron sucrose(n =14)were administered to anemic MHD patients for 2 months.By using 16 Sr RNA high-throughput sequencing technique,feces samples were gathered at baseline and after therapy to evaluate changes in gut microbiome.Results:To varied degrees,oral iron and intravenous iron repaired renal anemia,with intravenous iron being more effective.Oral and intravenous iron treatments had different effects on gut microbial composition and diversity.After oral iron treatment,the Alpha diversity was decreased,while at the phylum level,the abundance of Firmicutes was reduced and the abundance of Bacteroides was increased.At the genus level,the abundance of bacteria producing short chain fatty acids such as Blautia and Coprococcus was decreased,and the abundance of Bacteroidetes was increased.By LEf Se analysis,oral iron therapy was associated with a higher abundance of Lactobacillus,and intravenous iron therapy was associated with a higher abundance of Akkermansia.According to metagenome function prediction analysis,oral iron increased the metabolic processes of phenylalanine,valine,leucine,and isoleucine.Intravenous iron increased biosynthesis of unsaturated fatty acids.Conclusion:In terms of iron supplementation,intravenous iron is superior to oral iron.Iron therapy affects the diversity and composition of gut flora in MHD patients.Oral iron decreases the diversity of bacteria,reduces the abundance of bacteria producing short-chain fatty acids and increases amino acid metabolism and the abundance of Lactobacillus compared with intravenous iron.Intravenous iron increases the abundance of Akkermansia Muciniphila.