Department of Renal Medicine, King's College Hospital, Bessemer Road, London SE5 9RS, UK.
Curr Med Res Opin. 2010 Feb;26(2):473-82. doi: 10.1185/03007990903512461.
The management of iron-deficiency anaemia in patients with non-dialysis chronic kidney disease (ND-CKD) remains controversial, particularly regarding the use of oral versus intravenous iron supplementation.
A PubMed search from 1970 to February 2009 was conducted to identify relevant research articles.
Iron supplementation is advisable for all iron-deficient CKD patients receiving erythropoiesis stimulating agents (ESAs), and intravenous iron may be preferable to oral iron. However, there is also a growing body of data indicating that iron supplementation may avoid or delay the need for ESA therapy in some ND-CKD patients. In each of four randomised trials that included ND-CKD patients without ESA, the haemoglobin response was greater with i.v. versus oral iron. Moreover, some ND-CKD patients who remain anaemic on oral iron may subsequently respond to i.v. iron. Newer preparations (ferric carboxymaltose and ferumoxytol) permit rapid, high-dose administration. In a randomised study, a single 15-minute injection of ferric carboxymaltose, with up to two additional doses as required, resulted in 53.2% of ND-CKD patients achieving > or =1 g/dL increase in haemoglobin by day 56 without ESA, compared to 29.9% of patients given oral iron supplements. Two large, randomised, ongoing trials will address the important question of whether i.v. or oral iron supplementation affects the progression of renal dysfunction. While i.v. iron is more costly than oral iron, the cost differential over time may be lower than widely believed, and i.v. therapy avoids the poor absorption, gastrointestinal intolerance and non-compliance associated with oral preparations. In terms of safety, true anaphylaxis does not occur with modern preparations such as iron sucrose and iron gluconate. The novel preparations ferric carboxymaltose and ferumoxytol do not require a test dose and appear to offer a good safety profile, but long-term safety monitoring is mandatory.
Intravenous iron offers an effective, feasible route towards reducing the heavy burden of iron-deficiency anaemia in the non-dialysis CKD patient, even in the absence of ESA therapy.
非透析慢性肾脏病（ND-CKD）患者的缺铁性贫血的治疗仍存在争议，尤其是口服与静脉铁补充的比较。
检索 1970 年至 2009 年 2 月间的 PubMed 文献，以明确相关研究文章。
所有接受红细胞生成刺激剂（ESA）治疗的铁缺乏性 CKD 患者都应补铁，静脉铁剂可能优于口服铁剂。但也有越来越多的数据表明，铁补充可能避免或延迟某些 ND-CKD 患者对 ESA 的需求。在四项纳入 ND-CKD 患者且未用 ESA 的随机试验中，静脉铁剂较口服铁剂更能提高血红蛋白水平。而且，一些口服铁剂治疗仍贫血的 ND-CKD 患者可能会对静脉铁剂有反应。新型制剂（羧基麦芽糖铁和右旋糖酐铁）可实现快速、高剂量给药。在一项随机研究中，53.2%的 ND-CKD 患者接受单次 15 分钟羧基麦芽糖铁注射，必要时可加用两剂，至第 56 天，血红蛋白较基线增加>或=1 g/dL，而接受口服铁剂治疗的患者为 29.9%。两项大型、随机、正在进行的试验将解决静脉铁或口服铁补充是否影响肾功能恶化的重要问题。虽然静脉铁比口服铁更昂贵，但随着时间的推移，成本差异可能低于普遍认为的那样，而且静脉治疗避免了口服制剂相关的吸收不良、胃肠道不耐受和不依从性。就安全性而言，现代制剂如蔗糖铁和葡萄糖酸铁不会引起真正的过敏反应。新型制剂羧基麦芽糖铁和右旋糖酐铁不需要皮试，且似乎具有良好的安全性，但必须进行长期安全性监测。
静脉铁剂为非透析 CKD 患者减轻缺铁性贫血这一沉重负担提供了有效、可行的途径，即使在无 ESA 治疗的情况下也是如此。
