Iron Deficiency and FGF23 Regulation in CKD and HF

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

Official Title
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Iron Deficiency and Fibroblast Growth Factor 23 Regulation in Chronic Kidney Disease and Heart Failure

Conditions
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Chronic Kidney Diseases, Chronic Heart Failure, Iron Deficiency Anemia

Intervention / Treatment
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* Drug: Iron Sucrose


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Iron Sucrose Treatment<br>All patients with iron deficiency anemia (those without CKD or HF, those with CKD only, those with HF only, and those with CKD/HF) will be given 5 weekly doses of 200 mg of intravenous iron sucrose. | Drug: Iron Sucrose<br>* All participants will be given intravenous iron sucrose (200 mg) weekly for 5 weeks. Iron sucrose is infused over 60 minutes.<br>* Other names: Venofer;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in c-terminal FGF23 measurements | longitudinal change in plasma c-terminal FGF23 (RU/ml) over 6 weeks and 3 months | Weekly x 6 weeks, 1 longitudinal measurement at 3 months | 
| Change in Intact FGF23 measurements | longitudinal change in plasma intact FGF23 (pg/ml) over 6 weeks and 3 months | Weekly x 6 weeks, 1 longitudinal measurement at 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Parathyroid Hormone | longitudinal change in Serum Parathyroid Hormone (pg/ml) over 6 weeks and 3 months | Weekly x 6 weeks, 1 longitudinal measurement at 3 months | 
| Change in Phosphate (mg/dl) | longitudinal change in Plasma Phosphate (mg/dl) over 6 weeks and 3 months | Weekly x 6 weeks, 1 longitudinal measurement at 3 months | 
| Change in Serum creatinine | longitudinal change in Serum creatinine (mg/dl) over 6 weeks and 3 months | Weekly x 6 weeks, 1 longitudinal measurement at 3 months | 
| Change in 1,25 dihydroxyvitamin D | longitudinal change in 1,25 dihydroxyvitamin D (pg/ml) over 6 weeks and 3 months | Weekly x 6 weeks, 1 longitudinal measurement at 3 months | 
| Change in C-reactive protein | longitudinal change in C-reactive protein (mg/L) over 6 weeks and 3 months | Weekly x 6 weeks, 1 longitudinal measurement at 3 months | 
| Change in Ferritin Measurement | longitudinal change in serum ferritin (ng/ml) over 6 weeks and 3 months | Weekly x 6 weeks, 1 longitudinal measurement at 3 months | 
| Change in Iron Measurement | longitudinal change in Serum iron (ug/dl) over 6 weeks and 3 months | Weekly x 6 weeks, 1 longitudinal measurement at 3 months | 
| Change in Transferrin Saturation | longitudinal change in Transferrin Saturation (%) over 6 weeks and 3 months | Weekly x 6 weeks, 1 longitudinal measurement at 3 months | 
| Change in Hemoglobin Measurement | longitudinal change in Serum hemoglobin (g/dl) over 6 weeks and 3 months | Weekly x 6 weeks, 1 longitudinal measurement at 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Iron Deficiency, Fibroblast Growth Factor 23, Phosphate