Sharma Amit, Vanderhalt Kirsten, Ryan Kenneth J, Sclafani Jo
Boise Kidney and Hypertension Institute, Meridian, Idaho, USA.
Nephrol News Issues. 2010 Apr;24(4):22-6, 29-35.
Intravenous (IV) iron is a necessary component of the anemia management plan for the hemodialysis patient. Despite the demonstrated benefits of IV iron, questions remain as to the most effective strategies for using IV iron to maintain target hemoglobin (Hb) levels, ensure adequate iron supply, and optimize erythropoiesis-stimulating agent (ESA) therapy. Significant questions also surround the extent of the serum ferritin marker to reliably guide IV iron treatment decisions. The recent Dialysis Patients' Response to IV Iron with Elevated Ferritin (DRIVE) and DRIVE-II studies showed that improvements in Hb levels, iron status, and ESA responsiveness can be achieved with a repletion course of IV iron in patients with serum ferritin levels up to 1200 ng/mL. These studies also demonstrated that higher serum ferritin levels are a poor predictor of positive response to IV iron. We sought to apply the lessons learned from the DRIVE studies in our hemodialysis clinic. We designed this retrospective study to determine if regular, low-dose IV iron administered to patients with serum ferritin levels up to 1200 ng/mL could improve measures of anemia and iron status while optimizing the use of IV iron and ESAs.
静脉注射铁剂是血液透析患者贫血管理计划的必要组成部分。尽管静脉注射铁剂已显示出诸多益处，但关于使用静脉注射铁剂维持目标血红蛋白（Hb）水平、确保充足铁供应以及优化促红细胞生成素（ESA）治疗的最有效策略仍存在疑问。血清铁蛋白标志物在可靠指导静脉注射铁剂治疗决策方面的适用范围也存在重大疑问。最近的“透析患者对铁蛋白升高时静脉注射铁剂的反应（DRIVE）”和“DRIVE-II”研究表明，血清铁蛋白水平高达1200 ng/mL的患者，通过静脉注射铁剂补充疗程可实现Hb水平、铁状态和ESA反应性的改善。这些研究还表明，较高的血清铁蛋白水平并不能很好地预测对静脉注射铁剂的阳性反应。我们试图将从DRIVE研究中学到的经验应用于我们的血液透析诊所。我们设计了这项回顾性研究，以确定对血清铁蛋白水平高达1200 ng/mL的患者定期给予低剂量静脉注射铁剂是否能在优化静脉注射铁剂和ESA使用的同时改善贫血和铁状态指标。
