Ruiz-Jaramillo Ma de la Cruz, Guízar-Mendoza Juan Manuel, Gutiérrez-Navarro María de Jesús, Dubey-Ortega Luis Antonio, Amador-Licona Norma
Mexican Institute of Social Security, León, México.
Pediatr Nephrol. 2004 Jan;19(1):77-81. doi: 10.1007/s00467-003-1288-9. Epub 2003 Nov 22.
In patients with renal anemia, iron therapy can be administered intermittently or regularly at a low dose. We performed a randomized clinical trial in pediatric patients with end-stage renal failure on hemodialysis and absolute or functional iron deficiency. The study group received maintenance iron therapy according to the ferritin serum levels and the control group received intermittent 10-weekly doses. Success was defined as stabilization of ferritin levels between 100 and 800 microg/l and transferrin saturation (TSAT) between 20% and 50%, in addition to an increase in the hemoglobin level. The major reason for exclusion was iron overload. The study group received 6 mg/kg per month of parenteral iron [95% confidence interval (CI) 3.3-8.8] and the control group 14.4 mg/kg per month (95% CI 12-16.8) ( P<0.001). After 4 months of treatment, ferritin levels increased to 66 microg/l (95% CI 69-200) in the study group and to 334 microg/l (95% CI 145-522) in the control group ( P=0.009). Maintenance therapy and intermittent weekly doses were successful in 73% and 38%, respectively. After 3 months of treatment, hemoglobin levels increased to 10 g/dl, with no difference between the groups. However, in the control group the increase in hemoglobin levels was unsustained, and 3 patients needed transfusion. Patients in the control group had a higher risk of iron overload than patients in the study group (70% vs. 19%). Thus, the regimen based on assessment of serum ferritin levels was more efficient than the intermittent regimen because it increased and maintained the hemoglobin levels with lower iron doses and a lower risk of iron overload.
对于肾性贫血患者，铁剂治疗可采用间歇性或低剂量规律给药。我们对患有终末期肾衰竭且接受血液透析以及存在绝对或功能性缺铁的儿科患者进行了一项随机临床试验。研究组根据血清铁蛋白水平进行维持性铁剂治疗，对照组接受每10周一次的间歇性给药。成功的定义为铁蛋白水平稳定在100至800微克/升之间，转铁蛋白饱和度（TSAT）在20%至50%之间，同时血红蛋白水平有所升高。排除的主要原因是铁过载。研究组每月接受6毫克/千克的胃肠外铁剂治疗[95%置信区间（CI）3.3 - 8.8]，对照组每月接受14.4毫克/千克（95% CI 12 - 16.8）（P<0.001）。治疗4个月后，研究组铁蛋白水平升至66微克/升（95% CI 69 - 200），对照组升至334微克/升（95% CI 145 - 522）（P = 0.009）。维持性治疗和间歇性每周给药的成功率分别为73%和38%。治疗3个月后，血红蛋白水平升至10克/分升，两组之间无差异。然而，对照组血红蛋白水平的升高未得到维持，有3名患者需要输血。对照组患者发生铁过载的风险高于研究组患者（70%对19%）。因此，基于血清铁蛋白水平评估的治疗方案比间歇性治疗方案更有效，因为它能以更低的铁剂量和更低的铁过载风险提高并维持血红蛋白水平。
