Influence of parenteral iron therapy and oral vitamin E supplementation on neutrophil respiratory burst in chronic hemodialysis patients.
BACKGROUND
Bioincompatibility of hemodialysis (HD) membranes is responsible for neutrophil activation leading to oxidative stress, which can be further increased by intravenous (IV) iron (Fe) administration. The aim of our study was to monitor neutrophil respiratory burst during HD and to find out whether this process is influenced by IV Fe and oral vitamin E administration.


METHODS
Within four HD sessions, blood samples were taken from seven chronic HD patients at time 0 (before HD), 60, 70, and 130 min of HD session. Neutrophil respiratory burst was assessed by luminol-enhanced chemiluminescence (CL). Plasma advanced oxidation protein products (AOPP) concentration was measured spectrophotometrically. During the second and the fourth HD, 62.5 mg of sodium ferric gluconate was applied IV in the 65th minute of HD. Before the last two HD, the patients were given orally 200 mg of vitamin E daily for 7 days. Patient's results were compared with healthy controls.


RESULTS
Predialysis CL is higher in patients than in controls (1,926 +/- 436 vs. 1,083 +/- 325 RLU, p<.01). CL decreases in the 60th min of HD (1,926 +/- 436 vs. 1,220 +/- 599 RLU, p<.05); thereafter, it remains stable. After Fe application, CL increases at time 130 compared with CL at time 60 (1,303 +/- 269 vs. 877 +/- 292 RLU, p<.05). AOPP concentration is higher in patients than in controls (137.5 +/- 42.7 vs. 88.9 +/- 24.8 micromol/L, p<.01) and remains unaffected by vitamin E supplementation. After vitamin E intake, predialysis CL remains significantly higher than in controls, and changes in CL during HD are minimal despite Fe administration.


CONCLUSIONS
HD patients' neutrophils generate more oxygen radicals than in healthy individuals. This production decreases during HD and then increases after IV Fe administration. Short-term vitamin E administration attenuates this fluctuation of neutrophil oxidative metabolism, without affecting the total degree of oxidative stress.
Hodkova
Magdalena
M
Department of Medicine Strahov, Institute of Medical Biochemistry, General Teaching Hospital, and 1st Faculty of Medicine, Charles University, Prague, Czech Republic. mhorejsi@email.cz
Dusilova-Sulkova
Sylvie
S
Skalicka
Anna
A
Kalousova
Marta
M
Zima
Tomas
T
Bartunkova
Jirina
J
D000284:Administration, Oral; D000368:Aged; D001672:Biocompatible Materials; D016022:Case-Control Studies; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D007501:Iron / Q000008:administration & dosage / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000628:therapy; D008163:Luminescent Measurements; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D018384:Oxidative Stress; D006435:Renal Dialysis; D016897:Respiratory Burst / Q000187:drug effects*; D014810:Vitamin E / Q000008:administration & dosage / Q000627:therapeutic use*
D001672:Biocompatible Materials; D005290:Ferric Compounds; D008567:Membranes, Artificial; D014810:Vitamin E; D007501:Iron; C035552:ferric gluconate