Iron Deficiency and FGF23 Regulation in CKD and HF
| Status: | Completed |
|---|---|
| Conditions: | Iron Deficiency Anemia, Renal Impairment / Chronic Kidney Disease, Cardiology, Anemia |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Hematology, Nephrology / Urology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 3/22/2019 |
| Start Date: | December 18, 2015 |
| End Date: | August 1, 2018 |
Iron Deficiency and Fibroblast Growth Factor 23 Regulation in Chronic Kidney Disease and Heart Failure
This study investigates the effects of intravenous (IV) iron sucrose therapy on blood levels
of Fibroblast Growth Factor 23 (FGF23, a protein that regulates the amount of phosphate in
the body) in iron deficiency anemia in healthy participants, participants with Congestive
Heart Failure (CHF, where the heart does not pump adequate blood supply to the body),
participants with Chronic Kidney Disease (CKD, where the kidney function is reduced), and
participants with CKD and CHF.
of Fibroblast Growth Factor 23 (FGF23, a protein that regulates the amount of phosphate in
the body) in iron deficiency anemia in healthy participants, participants with Congestive
Heart Failure (CHF, where the heart does not pump adequate blood supply to the body),
participants with Chronic Kidney Disease (CKD, where the kidney function is reduced), and
participants with CKD and CHF.
Iron is a key part of our red blood cells which bring oxygen to our body's tissues. Without
iron, our blood cannot carry oxygen. The body normally gets iron through diet and it also
re-uses iron from old red blood cells. When iron stores are low, patients get iron deficiency
anemia. This can happen because patients lose more red blood cells and iron than the body can
replace, the body does not do a good job at absorbing iron from the diet, or the body is able
to absorb iron but patients are not getting enough iron from their diets. Many patients with
chronic diseases such as CKD and CHF also have iron deficiency anemia.
Iron deficiency may also cause a hormone in the body named FGF23 to rise. FGF23 is a hormone
that is made in bone and has an important role in the heart and kidney. When the kidneys are
not working properly, as in CKD, or when the heart is not pumping correctly, as in CHF, FGF23
levels in the blood go up. Many patients with CKD or CHF also have low levels of iron. In
these cases, FGF23 levels may rise even more. Too much FGF23 in the blood may lead to an
increased risk of heart problems and accelerate loss of kidney function. The best way to
control FGF23 levels in the blood in CKD and CHF is not known.
The investigators are conducting a 6-week iron deficiency anemia study on healthy
individuals,individuals with CKD, and individuals with CHF to find out if treating iron
deficiency anemia with intravenous iron sucrose therapy can safely and successfully lower
FGF23 levels. Iron sucrose has been shown to lower FGF23 in animal models. The short term
effects of iron sucrose on FGF23 levels in CKD and CHF are not known.
iron, our blood cannot carry oxygen. The body normally gets iron through diet and it also
re-uses iron from old red blood cells. When iron stores are low, patients get iron deficiency
anemia. This can happen because patients lose more red blood cells and iron than the body can
replace, the body does not do a good job at absorbing iron from the diet, or the body is able
to absorb iron but patients are not getting enough iron from their diets. Many patients with
chronic diseases such as CKD and CHF also have iron deficiency anemia.
Iron deficiency may also cause a hormone in the body named FGF23 to rise. FGF23 is a hormone
that is made in bone and has an important role in the heart and kidney. When the kidneys are
not working properly, as in CKD, or when the heart is not pumping correctly, as in CHF, FGF23
levels in the blood go up. Many patients with CKD or CHF also have low levels of iron. In
these cases, FGF23 levels may rise even more. Too much FGF23 in the blood may lead to an
increased risk of heart problems and accelerate loss of kidney function. The best way to
control FGF23 levels in the blood in CKD and CHF is not known.
The investigators are conducting a 6-week iron deficiency anemia study on healthy
individuals,individuals with CKD, and individuals with CHF to find out if treating iron
deficiency anemia with intravenous iron sucrose therapy can safely and successfully lower
FGF23 levels. Iron sucrose has been shown to lower FGF23 in animal models. The short term
effects of iron sucrose on FGF23 levels in CKD and CHF are not known.
Inclusion Criteria:
- Age ≥ 18 years old
- Ability to understand and the willingness to sign a written informed consent.
- Iron Deficiency Anemia, as defined by
- Ferritin level < 100 ng/ml or
- Transferrin saturation <20% with ferritin 100-350 ng/ml and
- Hemoglobin < 12 g/dl
Exclusion Criteria:
- Hypersensitivity to any component of iron sucrose
- Malignancy within 5 years
- End stage renal disease or kidney transplantation
- Erythropoiesis stimulating agents
- Red blood cell transfusions within last 60 days
- Current radiotherapy or chemotherapy
- Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels greater than
1.5 times normal
- Hemochromatosis
- Chronic digestive diseases
- Pregnancy or nursing
- Active alcohol or drug abuse
- Uncontrolled hypertension
- Active infection
- Hospitalization in the 4 preceding weeks
- Concomitant use of antibiotics
- Concomitant use of immunosuppression
- Inability to consent.
- Conditions, in which of the opinion of the investigator, make participation
unacceptable
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