Kapoian Toros
UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA.
Am J Kidney Dis. 2008 Dec;52(6 Suppl):S21-8. doi: 10.1053/j.ajkd.2008.09.004.
Clinicians who manage anemia in patients with chronic kidney disease, both on and off dialysis therapy, face several challenges: maintain stable hemoglobin (Hb) levels in their patients, avoid overshooting Hb targets, balance intravenous (IV) iron and erythropoiesis-stimulating agents (ESAs), and improve ESA response to use the lowest effective ESA dose. Special attention to ESA hyporesponsiveness, as well as the role of insufficient iron, is required. The efficacy of IV iron in managing these challenges, particularly in hemodialysis patients who have anemia despite adequate ESA doses, was shown in the randomized controlled Dialysis Patients' Response to IV Iron with Elevated Ferritin (DRIVE) clinical trial and its 6-week follow-up extension study, DRIVE-II. These studies provide suggestive evidence of the ability of IV iron to reduce ESA requirements and maintain improved Hb levels in anemic hemodialysis patients with serum ferritin levels of 500 to 1,200 ng/mL and transferrin saturations of 25% or less.
无论是进行透析治疗还是未进行透析治疗的慢性肾脏病患者贫血的临床管理医生，都面临着几个挑战：维持患者稳定的血红蛋白（Hb）水平，避免超过Hb目标值，平衡静脉注射（IV）铁剂和促红细胞生成素（ESA），并改善ESA反应以使用最低有效剂量的ESA。需要特别关注ESA低反应性以及铁不足的作用。静脉注射铁剂在应对这些挑战方面的疗效，尤其是在尽管使用了足够剂量的ESA仍患有贫血的血液透析患者中，在随机对照的“铁蛋白升高的透析患者对静脉注射铁剂的反应”（DRIVE）临床试验及其为期6周的随访扩展研究DRIVE-II中得到了证实。这些研究提供了提示性证据，表明静脉注射铁剂能够降低贫血血液透析患者（血清铁蛋白水平为500至1200 ng/mL且转铁蛋白饱和度为25%或更低）的ESA需求，并维持改善后的Hb水平。
