Venous versus arterial iron administration in haemodialysis. Influence on erythrocytes antioxidant parameters.

Introduction Intravenous iron administration in patients treated by haemodialysis for end stage renal disease can exacerbate oxidative stress by increasing the level of free redox active iron. A way to reduce the impact of iron on oxidative stress in haemodialysis patients may be the administration of iron through arterial extracorporeal circuit. Objective The aim of our study was to compare the influence of iron route of administration (venous versus arterial extracorporeal circuit infusion) on antioxidant parameters in red blood cells of haemodialysis patients in order to clarify if arterial iron administration can have positive impacts related to iron induced oxidative stress. Method Twenty stable patients on regular haemodialysis treatment were selected for the study. They were investigated in a cross-over design at 3 mid-week HD sessions, one week apart, without iron [HD basal] and with either IV infusion of 100mg iron sucrose over the first 20 minutes of HD session, via venous line [HDvenous], or the same solution infused on the arterial extracorporeal circulation [HDarterial]. Blood samples were drawn at 0 min, 40 min and 270 min. Erythrocytes superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px) activity, non-protein thiol levels and total antioxidant capacity (TEAC) were analysed. Conclusion Haemodialysis significantly decreases the total antioxidant activity in erythrocytes. Iron supplementation, through venous or arterial extracorporeal route has no impact on the total antioxidant activity in red blood cells. Venous iron administration increases GPx activity in erythrocytes suggesting increased lipid peroxidation compared with arterial extracorporeal administration.

Study of fluticasone propionate efficacy in the treatment of patients with bronchial asthma not controlled by other inhaled corticosteroids.

The aim of the study was to test the fluticasone propionate (FP) efficacy in the treatment of patients with bronchial asthma (BA), not controlled by high doses (more than 1 mg) of other inhaled corticosteroids. Asthma symptoms (degree of dyspnea on Sadoul scale, percentage of symptom-free days and nights), and drug consumption were measured and lung function tests were performed in 20 patients (11 women and 9 men, mean age 47 years) for a 2 months period. Biochemical measurements were done referring to oxidant/antioxidant imbalance, which is characteristic to inflammatory diseases of respiratory system. We evaluated lipoperoxidation (LPO) in the plasma and the blood, before and after FP treatment, by determining malondialdehyde (MDA) status, superoxide-dismutase and ceruloplasmine activity and non-protein SH groups (essential glutathione) status. The biochemical measurements showed a significant decrease in lipid peroxides level in the plasma and the blood and a slight increase of glutathione after 2 months treatment with FP. Lung function tests were performed on a Flow Streen Jaeger and we determined: peak expiratory flow (PEF), vital capacity (VC), forced expiratory volume in 1 sec. (FEV1) and mid-expiratory flow at 50% VC (MEF50). The measurements were done before FP administration, after 3 days, 7 days, 1 month and 2 months. The dose of FP was equivalent to 50-75% of the daily dose of Beclomethasone dipropionate (BD) previously administered. The degree of dyspnea diminished from 3-4 to 0-1. The percentage of symptom-free days and nights improved from 12% to 78% and 25% to 95% respectively. The use of short acting beta agonists diminished with 75% and no patients required i.v. corticotherapy or theophylline. PEF increased with a mean of 25%, VC with a mean of 23%, FEV1 with a mean of 30% and MEF50 with a mean of 36%. Our results demonstrate improved efficacy of FP vs high doses of other inhaled corticosteroids in the treatment of moderate persistent and severe forms of BA.