Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI 48301, USA.
Nat Rev Nephrol. 2010 Dec;6(12):699-710. doi: 10.1038/nrneph.2010.139. Epub 2010 Oct 19.
Iron deficiency is prevalent in patients with chronic kidney disease (CKD), and use of oral and intravenous iron in patients with CKD who do not require dialysis might obviate or delay the need for treatment with eythropoiesis-stimulating agents (ESAs). Patients on hemodialysis have lower intestinal iron absorption, greater iron losses, and require greater iron turnover to maintain the ESA-driven red cell mass than do healthy individuals. In these patients, intravenous iron reduces ESA dose requirements and increases the likelihood of maintaining levels of hemoglobin within the desired range. Oral iron is inferior to intravenous iron in patients on hemodialysis, in part because elevated serum levels of hepcidin prevent intestinal absorption of iron. Increased levels of hepcidin also impair the normal recycling of iron through the reticuloendothelial system. Levels of serum ferritin and transferrin saturation below 450 pmol/l and 20%, respectively are indicative of iron deficiency, but values above the normal range lack diagnostic value in patients with CKD on dialysis. The availability of various iron preparations and new developments in delivering iron should enable adequate provision of iron to patients with CKD. This Review examines the efficacy, safety and use of iron supplementation therapy for the treatment of anemia in patients with CKD.
缺铁在慢性肾脏病（CKD）患者中很常见，对于不需要透析的 CKD 患者，使用口服和静脉铁剂可能可以避免或延迟使用促红细胞生成素刺激剂（ESA）的治疗需求。血液透析患者的肠道铁吸收减少，铁丢失更多，并且需要更大的铁周转率来维持 ESA 驱动的红细胞量，这与健康个体不同。在这些患者中，静脉铁剂可减少 ESA 剂量需求，并增加维持血红蛋白在所需范围内的可能性。在血液透析患者中，口服铁剂不如静脉铁剂，部分原因是升高的血清铁调素水平阻止了铁的肠道吸收。铁调素水平升高也会损害网状内皮系统中铁的正常循环。血清铁蛋白和转铁蛋白饱和度分别低于 450 pmol/L 和 20%表明存在缺铁，但在接受透析治疗的 CKD 患者中，这些值高于正常范围缺乏诊断价值。各种铁制剂的可用性和铁输送方面的新进展，应该能够为 CKD 患者提供充足的铁供应。这篇综述探讨了铁补充治疗治疗 CKD 患者贫血的疗效、安全性和应用。
