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

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.

MATERIAL and METHOD: 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.

RESULTS: 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.

CONCLUSION: 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