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Hemodiyaliz tedavisi alan hastalarda demir sükrozun intradiyalitik kan basıncına etkisi

Year 2026, Volume: 7 Issue: 1, 14 - 19, 20.02.2026
https://izlik.org/JA72AD53NA

Abstract

Amaçlar: İntravenöz demir sükrozun vazoaktif olduğu ve hemodiyaliz hastalarında intradiyalitik kan basıncında değişikliklere yol açtığını gösteren çalışmalar vardır. İntradiyalitik hipotansiyonun vasküler tromboz, yetersiz diyaliz ve artmış mortalite ile ilişkili olduğu bildirilmiştir. İntradiyalitik hipertansiyonun ise bazı çalışmalarda artmış kardiyovasküler mortalite ve hastaneye yatış sıklığında artış ile ilişkili olduğu gösterilmiştir. Bu çalışmada, demir sükrozun hemodiyaliz hastalarında intradiyalitik kan basıncı üzerine etkisini araştırmayı amaçladık.
Yöntemler: Bu çalışmada, haftada üç kez hemodiyalize giren 59 hastanın kan basınçları hemodiyaliz öncesinde ölçülerek 0. dakikada kaydedildi. Diyaliz tedavisinin ilk 30 dakikasında 100 mg/5 ml demir sükroz IV infüzyon şeklinde uygulandı ve her 30 dakikada bir kan basıncı ölçülerek kaydedildi. Aynı hastaların demir sükroz uygulanmayan bir sonraki hemodiyaliz seansında da her 30 dakikada bir kan basınçları ölçüldü.
Bulgular: İki farklı hastada intradiyalitik hipotansiyon gelişti; bunlardan biri demir sükroz verilen seansta, diğeri ise demir sükroz verilmeyen seansta görüldü. İntradiyalitik hipertansiyon açısından üç farklı tanıma göre gruplar arasında anlamlı bir fark saptanmadı (p=0,134; 0,523; ve 1, sırasıyla).
Sonuçlar: Demir sükroz uygulamasının ne intradiyalitik hipotansiyona ne de intradiyalitik hipertansiyona yol açmadığını bulduk.

Ethical Statement

Çalışma protokolü yerel etik kurul tarafından onaylandı (onay no: 2024/024) ve çalışma Helsinki Deklarasyonuna uygun olarak yürütüldü.

References

  • Анемії К. KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Int. 2012;2:279. doi:10.1038/kisup.2012.37
  • Besarab A, Coyne DW. Iron supplementation to treat anemia in patients with chronic kidney disease. Nature Rev Nephrol. 2010;6(12):699-710. doi:10.1038/nrneph.2010.139
  • Macdougall IC, Tucker B, Thompson J, Tomson CR, Baker LR, Raine AE. A randomized controlled study of iron supplementation in patients treated with erythropoietin. Kidney Int. 1996;50(5):1694-1699. doi:10. 1038/ki.1996.487
  • Avni T, Bieber A, Grossman A, Green H, Leibovici L, Gafter-Gvili A. The safety of intravenous iron preparations: systematic review and meta-analysis. Elsevier; 2015:12-23.
  • Charytan C, Levin N, Al-Saloum M, Hafeez T, Gagnon S, Van Wyck DB. Efficacy and safety of iron sucrose for iron deficiency in patients with dialysis-associated anemia: North American clinical trial. Am J Kidney Dis. 2001;37(2):300-307. doi:10.1053/ajkd.2001.21293
  • Singh AT, Yen TE, Mothi SS, Waikar SS, Mc Causland FR. Associations of iron sucrose and intradialytic blood pressure. Am J Kidney Dis. 2023; 81(6):647-654. doi:10.1053/j.ajkd.2022.11.007
  • Johansen KL, Chertow GM, Foley RN, et al. US renal data system 2020 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis. 2021;77(4):A7-A8. doi:10.1053/j.ajkd.2021.01.002
  • Seyahi N, Kocyigit İ, Eren N, et al. Current status of kidney replacement therapy in Turkiye: a summary of 2022 Turkish Society of Nephrology registry report. Turk J Nephrol. 2024;33(2):134-139. doi:10.5152/turkjnephrol.2025.24978
  • Flythe JE, Xue H, Lynch KE, Curhan GC, Brunelli SM. Association of mortality risk with various definitions of intradialytic hypotension. J Am Soc Nephrol. 2015;26(3):724-734. doi:10.1681/ASN.2014020222
  • Chang TI, Paik J, Greene T, et al. Intradialytic hypotension and vascular access thrombosis. J Am Soc Nephrol. 2011;22(8):1526-1533. doi:10.1681/ASN.2010101119
  • Ronco C, Brendolan A, Milan M, Rodeghiero MP, Zanella M, La Greca G. Impact of biofeedback-induced cardiovascular stability on hemodialysis tolerance and efficiency. Kidney Int. 2000;58(2):800-808. doi:10.1046/j.1523-1755.2000.00229.x
  • Shoji T, Tsubakihara Y, Fujii M, Imai E. Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in hemodialysis patients. Kidney Int. 2004;66(3):1212-1220. doi:10.1111/j. 1523-1755.2004.00812.x
  • Iatridi F, Theodorakopoulou MP, Karpetas A, et al. Association of peridialytic, intradialytic, scheduled interdialytic and ambulatory BP recordings with cardiovascular events in hemodialysis patients. J Nephrol. 2022;35(3):943-954. doi:10.1007/s40620-021-01205-9
  • Georgianos PI, Sarafidis PA, Zoccali C. Intradialysis hypertension in end-stage renal disease patients: clinical epidemiology, pathogenesis, and treatment. Hypertension. 2015;66(3):456-463. doi:10.1161/HYPERTENSIONAHA.115.058
  • Van Buren PN, Kim C, Toto RD, Inrig JK. The prevalence of persistent intradialytic hypertension in a hemodialysis population with extended follow-up. Int J Artif Organs. 2012;35(12):1031-1038. doi:10.1177/ 039139881203501201
  • Theofilis P, Vordoni A, Kalaitzidis RG. Epidemiology, pathophysiology, and clinical perspectives of intradialytic hypertension. Am J Nephrol. 2023;54(5-6):200-207. doi:10.1159/000531047
  • Macdougall IC, Bircher AJ, Eckardt K-U, et al. Iron management in chronic kidney disease: conclusions from a “Kidney Disease: Improving Global Outcomes”(KDIGO) Controversies Conference. Kidney Int. 2016;89(1):28-39. doi:10.1016/j.kint.2015.10.002
  • Mancia G, De Backer G, Dominiczak A, et al. 2007 guidelines for the management of arterial hypertension. J Hypertension. 2007;25(6):1105-1187.
  • Singh AT, Waikar SS, Mc Causland FR. Association of different definitions of intradialytic hypertension with long-term mortality in hemodialysis. Hypertension. 2022;79(4):855-862. doi:10.1161/HYPERTENSIONAHA.121.18058
  • Flythe JE, Chang TI, Gallagher MP, et al. Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2020;97(5):861-876. doi:10.1016/j.kint.2020.01.046
  • K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis. 2005;45(4 Suppl 3):S1-S153.
  • Kooman J, Basci A, Pizzarelli F, et al. EBPG guideline on haemodynamic instability. Nephrol Dial Transplant. 2007;22(Suppl 2):ii22-ii44. doi:10. 1093/ndt/gfm019
  • Aronoff GR, Bennett WM, Blumenthal S, et al. Iron sucrose in hemodialysis patients: safety of replacement and maintenance regimens. Kidney Int. 2004;66(3):1193-1198. doi:10.1111/j.1523-1755.2004.00872.x
  • Knovich MA, Storey JA, Coffman LG, Torti SV, Torti FM. Ferritin for the clinician. Blood Rev. 2009;23(3):95-104. doi:10.1016/j.blre.2008.08.001
  • Aljwaid H, White DL, Collard KJ, Moody AJ, Pinkney JH. Non-transferrin-bound iron is associated with biomarkers of oxidative stress, inflammation and endothelial dysfunction in type 2 diabetes. J Diabetes Complications. 2015;29(7):943-949. doi:10.1016/j.jdiacomp.2015.05.017
  • Kuo K-L, Hung S-C, Lin Y-P, et al. Intravenous ferric chloride hexahydrate supplementation induced endothelial dysfunction and increased cardiovascular risk among hemodialysis patients. PloS one. 2012;7(12):e50295. doi:10.1371/journal.pone.0050295
  • Stevens SL, Wood S, Koshiaris C, et al. Blood pressure variability and cardiovascular disease: systematic review and meta-analysis. BMJ. 2016; 354:i4098. doi:10.1136/bmj.i4098
  • Sheikh AB, Sobotka PA, Garg I, et al. Blood pressure variability in clinical practice: past, present and the future. J Am Heart Assoc. 2023; 12(9):e029297. doi:10.1161/JAHA.122.029297

Effect of iron sucrose on intradialytic blood pressure in patients receiving maintenance hemodialysis treatment

Year 2026, Volume: 7 Issue: 1, 14 - 19, 20.02.2026
https://izlik.org/JA72AD53NA

Abstract

Aims: There are studies showing that IV iron sucrose is vasoactive and causes changes in intradialytic blood pressure in hemodialysis patients. Intradialytic hypotension has been associated with vascular thrombosis, inadequate dialysis, and increased mortality. Intradialytic hypertension, has been shown in some studies to be associated with increased cardiovascular mortality and an increase in the frequency of hospitalization. In this study, we aimed to investigate the effect of iron sucrose on intradialytic blood pressure in hemodialysis patients.
Methods: In this study, 59 patients undergoing hemodialysis three times a week had their blood pressure measured before hemodialysis and recorded at minute 0. 100 mg/5 ml iron sucrose was administered as an IV infusion during the first 30 minutes of dialysis treatment, and blood pressure was measured and recorded every 30 minutes. The same patient's blood pressure was measured every 30 minutes during the next hemodialysis session without iron sucrose treatment.
Results: Intradialytic hypotension developed in two different patient; one patient in the session in which iron sucrose was given and one in the session in which iron sucrose was not given. There was no significant difference in intradialytic hypertension between the groups according to all three definitions of intradialytic hypertension (p=0.134; 0.523; and 1, respectively).
Conclusion: We found that iron sucrose administration does not cause both intradialytic hypotension and intradialytic hypertension.

Ethical Statement

The local ethics committee approved the study protocol (approval no:2024/024) and the study was carried out in accordance with the Helsinki Declaration.

References

  • Анемії К. KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Int. 2012;2:279. doi:10.1038/kisup.2012.37
  • Besarab A, Coyne DW. Iron supplementation to treat anemia in patients with chronic kidney disease. Nature Rev Nephrol. 2010;6(12):699-710. doi:10.1038/nrneph.2010.139
  • Macdougall IC, Tucker B, Thompson J, Tomson CR, Baker LR, Raine AE. A randomized controlled study of iron supplementation in patients treated with erythropoietin. Kidney Int. 1996;50(5):1694-1699. doi:10. 1038/ki.1996.487
  • Avni T, Bieber A, Grossman A, Green H, Leibovici L, Gafter-Gvili A. The safety of intravenous iron preparations: systematic review and meta-analysis. Elsevier; 2015:12-23.
  • Charytan C, Levin N, Al-Saloum M, Hafeez T, Gagnon S, Van Wyck DB. Efficacy and safety of iron sucrose for iron deficiency in patients with dialysis-associated anemia: North American clinical trial. Am J Kidney Dis. 2001;37(2):300-307. doi:10.1053/ajkd.2001.21293
  • Singh AT, Yen TE, Mothi SS, Waikar SS, Mc Causland FR. Associations of iron sucrose and intradialytic blood pressure. Am J Kidney Dis. 2023; 81(6):647-654. doi:10.1053/j.ajkd.2022.11.007
  • Johansen KL, Chertow GM, Foley RN, et al. US renal data system 2020 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis. 2021;77(4):A7-A8. doi:10.1053/j.ajkd.2021.01.002
  • Seyahi N, Kocyigit İ, Eren N, et al. Current status of kidney replacement therapy in Turkiye: a summary of 2022 Turkish Society of Nephrology registry report. Turk J Nephrol. 2024;33(2):134-139. doi:10.5152/turkjnephrol.2025.24978
  • Flythe JE, Xue H, Lynch KE, Curhan GC, Brunelli SM. Association of mortality risk with various definitions of intradialytic hypotension. J Am Soc Nephrol. 2015;26(3):724-734. doi:10.1681/ASN.2014020222
  • Chang TI, Paik J, Greene T, et al. Intradialytic hypotension and vascular access thrombosis. J Am Soc Nephrol. 2011;22(8):1526-1533. doi:10.1681/ASN.2010101119
  • Ronco C, Brendolan A, Milan M, Rodeghiero MP, Zanella M, La Greca G. Impact of biofeedback-induced cardiovascular stability on hemodialysis tolerance and efficiency. Kidney Int. 2000;58(2):800-808. doi:10.1046/j.1523-1755.2000.00229.x
  • Shoji T, Tsubakihara Y, Fujii M, Imai E. Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in hemodialysis patients. Kidney Int. 2004;66(3):1212-1220. doi:10.1111/j. 1523-1755.2004.00812.x
  • Iatridi F, Theodorakopoulou MP, Karpetas A, et al. Association of peridialytic, intradialytic, scheduled interdialytic and ambulatory BP recordings with cardiovascular events in hemodialysis patients. J Nephrol. 2022;35(3):943-954. doi:10.1007/s40620-021-01205-9
  • Georgianos PI, Sarafidis PA, Zoccali C. Intradialysis hypertension in end-stage renal disease patients: clinical epidemiology, pathogenesis, and treatment. Hypertension. 2015;66(3):456-463. doi:10.1161/HYPERTENSIONAHA.115.058
  • Van Buren PN, Kim C, Toto RD, Inrig JK. The prevalence of persistent intradialytic hypertension in a hemodialysis population with extended follow-up. Int J Artif Organs. 2012;35(12):1031-1038. doi:10.1177/ 039139881203501201
  • Theofilis P, Vordoni A, Kalaitzidis RG. Epidemiology, pathophysiology, and clinical perspectives of intradialytic hypertension. Am J Nephrol. 2023;54(5-6):200-207. doi:10.1159/000531047
  • Macdougall IC, Bircher AJ, Eckardt K-U, et al. Iron management in chronic kidney disease: conclusions from a “Kidney Disease: Improving Global Outcomes”(KDIGO) Controversies Conference. Kidney Int. 2016;89(1):28-39. doi:10.1016/j.kint.2015.10.002
  • Mancia G, De Backer G, Dominiczak A, et al. 2007 guidelines for the management of arterial hypertension. J Hypertension. 2007;25(6):1105-1187.
  • Singh AT, Waikar SS, Mc Causland FR. Association of different definitions of intradialytic hypertension with long-term mortality in hemodialysis. Hypertension. 2022;79(4):855-862. doi:10.1161/HYPERTENSIONAHA.121.18058
  • Flythe JE, Chang TI, Gallagher MP, et al. Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2020;97(5):861-876. doi:10.1016/j.kint.2020.01.046
  • K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis. 2005;45(4 Suppl 3):S1-S153.
  • Kooman J, Basci A, Pizzarelli F, et al. EBPG guideline on haemodynamic instability. Nephrol Dial Transplant. 2007;22(Suppl 2):ii22-ii44. doi:10. 1093/ndt/gfm019
  • Aronoff GR, Bennett WM, Blumenthal S, et al. Iron sucrose in hemodialysis patients: safety of replacement and maintenance regimens. Kidney Int. 2004;66(3):1193-1198. doi:10.1111/j.1523-1755.2004.00872.x
  • Knovich MA, Storey JA, Coffman LG, Torti SV, Torti FM. Ferritin for the clinician. Blood Rev. 2009;23(3):95-104. doi:10.1016/j.blre.2008.08.001
  • Aljwaid H, White DL, Collard KJ, Moody AJ, Pinkney JH. Non-transferrin-bound iron is associated with biomarkers of oxidative stress, inflammation and endothelial dysfunction in type 2 diabetes. J Diabetes Complications. 2015;29(7):943-949. doi:10.1016/j.jdiacomp.2015.05.017
  • Kuo K-L, Hung S-C, Lin Y-P, et al. Intravenous ferric chloride hexahydrate supplementation induced endothelial dysfunction and increased cardiovascular risk among hemodialysis patients. PloS one. 2012;7(12):e50295. doi:10.1371/journal.pone.0050295
  • Stevens SL, Wood S, Koshiaris C, et al. Blood pressure variability and cardiovascular disease: systematic review and meta-analysis. BMJ. 2016; 354:i4098. doi:10.1136/bmj.i4098
  • Sheikh AB, Sobotka PA, Garg I, et al. Blood pressure variability in clinical practice: past, present and the future. J Am Heart Assoc. 2023; 12(9):e029297. doi:10.1161/JAHA.122.029297
There are 28 citations in total.

Details

Primary Language English
Subjects Nefroloji
Journal Section Research Article
Authors

Fatih Ergül 0000-0001-7498-9710

Beyza Doğan 0000-0003-0461-1231

Mikail Dağ 0000-0002-8039-9036

Süleyman Karaköse 0000-0003-4680-7435

İbrahim Güney 0000-0002-1646-2811

Submission Date September 4, 2025
Acceptance Date December 31, 2025
Publication Date February 20, 2026
IZ https://izlik.org/JA72AD53NA
Published in Issue Year 2026 Volume: 7 Issue: 1

Cite

AMA 1.Ergül F, Doğan B, Dağ M, Karaköse S, Güney İ. Effect of iron sucrose on intradialytic blood pressure in patients receiving maintenance hemodialysis treatment. J Med Palliat Care / JOMPAC / jompac. 2026;7(1):14-19. https://izlik.org/JA72AD53NA

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Interuniversity Board (UAK) Equivalency: Article published in Ulakbim TR Index journal [10 POINTS], and Article published in other (excuding 1a, b, c) international indexed journal (1d) [5 POINTS]



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