Ibrahim Hassan N, Foley Robert N, Zhang Rui, Gilbertson David T, Collins Allan J
Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota 55404, USA.
Clin J Am Soc Nephrol. 2009 Mar;4(3):623-9. doi: 10.2215/CJN.03850808. Epub 2009 Feb 11.
Use of parenteral iron for anemia management in dialysis patients has greatly increased. Exceeding hemoglobin target levels is not without risk, and whether parenteral iron administration contributes to exceeding targets has not been tested. The authors aimed to determine prevalence of parenteral iron administration and its contribution to exceeding hemoglobin target levels.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The authors performed a retrospective observational study of 149,292 hemodialysis patients using Centers for Medicaid & Medicare Services data. All patients were point prevalent on January 1, 2004; survived through June 30, 2004; had Medicare as primary payer; were treated with erythropoiesis stimulating agents (ESAs); and had valid hemoglobin values in April, May, and June, 2004.
Of the cohort, 58% received parenteral iron; use was more likely among men, whites, younger patients, and patients with end-stage renal disease as a result of diabetes. Age > 75 yr, African American and other races, baseline hemoglobin > 12 g/dl, higher ESA dose, and iron use in months 1 to 4 of the study period were independently associated with the risk of exceeding hemoglobin levels of 12, 13, and 14 g/dl. Receiving iron in month 4 of the study period showed the highest probability of exceeding targets (odds ratios 1.49, 1.43, 1.50 for hemoglobin levels 12, 13, 14 g/dl, respectively).
Parenteral iron use is prevalent, and although adequate iron stores are central to ESA response, iron use may contribute to exceeding recommended hemoglobin levels. Only data from a prospective trial can confirm this association.
肠外铁剂在透析患者贫血管理中的使用大幅增加。血红蛋白超过目标水平并非没有风险，而肠外铁剂的使用是否会导致超过目标水平尚未得到验证。作者旨在确定肠外铁剂的使用情况及其对血红蛋白超过目标水平的影响。
设计、地点、参与者与测量：作者利用医疗补助与医疗照顾服务中心的数据，对149,292例血液透析患者进行了一项回顾性观察研究。所有患者在2004年1月1日为现患病例；存活至2004年6月30日；以医疗保险作为主要支付方；接受促红细胞生成素（ESA）治疗；并且在2004年4月、5月和6月有有效的血红蛋白值。
在该队列中，58%的患者接受了肠外铁剂治疗；男性、白人、年轻患者以及因糖尿病导致终末期肾病的患者更有可能使用。年龄>75岁、非裔美国人及其他种族、基线血红蛋白>12 g/dl、较高的ESA剂量以及在研究期间第1至4个月使用铁剂与血红蛋白水平超过12、13和14 g/dl的风险独立相关。在研究期间第4个月接受铁剂治疗显示超过目标水平的可能性最高（血红蛋白水平为12、13、14 g/dl时的优势比分别为1.49、1.43、1.50）。
肠外铁剂的使用很普遍，尽管充足的铁储备对于ESA反应至关重要，但铁剂的使用可能会导致血红蛋白水平超过推荐值。只有前瞻性试验的数据才能证实这种关联。
