Vychytil A, Haag-Weber M
Department of Medicine III, University Hospital of Vienna, Austria.
Kidney Int Suppl. 1999 Mar;69:S71-8. doi: 10.1046/j.1523-1755.1999.055suppl.69071.x.
Iron deficiency represents an important problem in peritoneal dialysis patients, especially during erythropoietin therapy. A combination of serum ferritin, transferrin saturation, and/or the percentage of hypochromic red cells should be used to assess iron status in peritoneal dialysis patients. Primarily, oral iron supplementation should be the preferred therapy. However, most of the studies using oral substitution in erythropoietin-treated peritoneal dialysis patients show a progressive decline of serum ferritin. Therefore, parenteral iron supplementation is required in part of the patients, and the intravenous route should be preferred in these cases. Intravenous iron therapy is recommended if serum ferritin falls below 100 microg/liter and should be stopped if the serum ferritin level is more than 650 microg/liter. The optimal form of intravenous iron supplementation is still unclear. Injections once to three times per week restrict the patients' flexibility, but application of higher doses in longer intervals may lead to an impairment of neutrophil functions, probably connected to a higher risk of infection. We treated 17 stable peritoneal dialysis patients with 100 or 200 mg iron saccharate monthly over a period of six months and found an increase of transferrin saturation (from 12.1+/-1.6 to 20.9+/-2.4%, P = 0.026), serum ferritin (from 100.4+/-32.0 to 372.4+/-54.6 microg/liter, NS) and hematocrit (from 32.0+/-0.8% to 35.1+/-0.9%, P = 0.099). The required erythropoietin dosage could be reduced significantly (from 148.4+/-30.3 to 69.4+/-19.5 U/kg/week, P = 0.025). Side effects occurred in 0.9% after application of 100 mg and in 5.9% after injection of 200 mg iron saccharate. The incidence of catheter infections and peritonitis was the same in the period before and after the start of treatment. Further studies are needed to find the most suitable regime of iron supplementation for peritoneal dialysis patients.
缺铁是腹膜透析患者面临的一个重要问题，尤其是在促红细胞生成素治疗期间。应结合血清铁蛋白、转铁蛋白饱和度和/或低色素红细胞百分比来评估腹膜透析患者的铁状态。首先，口服补铁应是首选治疗方法。然而，大多数关于促红细胞生成素治疗的腹膜透析患者口服补铁的研究显示血清铁蛋白呈逐渐下降趋势。因此，部分患者需要胃肠外补铁，在这些情况下应首选静脉途径。如果血清铁蛋白降至100微克/升以下，建议进行静脉铁剂治疗；如果血清铁蛋白水平超过650微克/升，则应停止治疗。静脉补铁的最佳方式仍不明确。每周注射一至三次限制了患者的灵活性，但较长间隔应用较高剂量可能会导致中性粒细胞功能受损，这可能与更高的感染风险有关。我们对17例稳定的腹膜透析患者每月给予100毫克或200毫克蔗糖铁，持续六个月，结果发现转铁蛋白饱和度升高（从12.1±1.6%升至20.9±2.4%，P = 0.026），血清铁蛋白升高（从100.4±32.0微克/升升至372.4±54.6微克/升，无显著性差异），血细胞比容升高（从32.0±0.8%升至35.1±0.9%，P = 0.099）。所需的促红细胞生成素剂量可显著降低（从148.4±30.3单位/千克/周降至69.4±19.5单位/千克/周，P = 0.025）。应用100毫克蔗糖铁后副作用发生率为0.9%，注射200毫克蔗糖铁后副作用发生率为5.9%。治疗开始前后导管感染和腹膜炎的发生率相同。需要进一步研究以找到最适合腹膜透析患者的补铁方案。
