The effect of intravenous iron replacement therapy on calcium, phosphorus and parathormone in stage 4-5-5d (peritoneum and hemodialysis patients) chronic kidney patients

OBJECTIVES: One of the most important problems that will affect the quality of life and even the progression of patients with CRF is the development of anemia. The aim of treating anemia and iron deficiency in patients with advanced CRF is to improve their symptoms and quality of life and potentially reduce their cardiovascular risks. Oral iron preparations are frequently used in the treatment, but intravenous iron replacement therapy is more frequently preferred nowadays because of the problems of tolerance of the drugs and the often unsatisfactory treatment response. has been started. In our study, it was planned to examine the effects of IV iron preparations, which are frequently used in treatment, on calcium, phosphorus and parathormone levels. MATERIALS AND METHODS: Thirty-two patients with advanced stage 4.5,5d CRF followed by Afyon Health Sciences University, Department of Nephrology were included in the study. The patients were divided into 2 groups as those who were treated with IV iron carboxymaltose and those who were treated with IV iron sucrose. The changes in a total of 4 measurements made for calcium, phosphorus and parathormone before and after iron replacement were examined within the groups. Analyzes were performed using SPSS 26.0 (IBM Corp. 2019 IBM SPSS Statistics for Windows, version 26.0. Armonk, NY: IBM Corp.). All p values were bidirectional and values with p ≤ 0.05 were considered statistically significant. RESULTS: When the iron sucrose and iron carboxymaltose groups were compared in terms of gender, age, CKD etiology and comorbidities, they were found to be similar. When the patients were compared in terms of laboratory parameters at the beginning of the study, urea, creatinine, eGFH, sodium, potassium, AST, ALT, hemoglobin, thrombocyte, calcium, phosphorus and parathormone levels of the patients were found to be similar. In terms of pre- and post-treatment calcium values, it was found that the calcium levels in the iron carboxymaltose group showed statistically significant variability (p<0.001), while the calcium values in the iron sucrose group were found to be similar (p= 0.351). In the post-hoc analyzes performed for the iron carboxymaltose group, it was determined that the pre-treatment calcium level and the calcium levels in the 1st week of the treatment and the calcium levels in the 1st month of the treatment and the 3rd month of the treatment were similar, while all other measurements were significantly different from each other. When the effects of iron replacement therapies on phosphorus were examined, it was determined that there was no statistically significant change in phosphorus levels in both groups at 3-month follow-ups. Again, in the analyzes made for parathormone, it was determined that the parathormone values of both groups did not vary significantly. CONCLUSION: It is supported by studies in the literature and our study that IV iron treatments may have effects on calcium, phosphorus and PTH levels in CKD patients. Randomized, controlled studies with larger participation are needed to demonstrate this effect. KEY WORDS: Calcium, Chronic Kidney Disease, Parathormon, Parenteral(IV) iron replacement, , Phosphorus, Stage 4-5-5D