1Division of Nephrology, 2Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY; and 3Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Am J Ther. 2014 Jul-Aug;21(4):250-3. doi: 10.1097/MJT.0b013e31825425bd.
For treating end-stage renal disease-associated anemia, various strategies to achieve optimal hemoglobin levels with lower erythropoiesis stimulating agent doses are being tried. One of these involves the use of a high dose [transferrin saturation (TSAT) >30%] of intravenous (IV) iron supplementation. However, due to in vitro effects of iron on stimulating bacterial growth, there are concerns of increased risk of infection. The safety of higher iron targets with respect to infectious complications (bacteremias, pneumonias, soft tissue infections, and osteomyelitis) is unknown. This was a retrospective study of patients on maintenance hemodialysis from a single, urban dialysis center to assess the long-term impact of the higher cumulative use of IV iron, on the incidence of clinically important infections. Our iron protocol was modified in June 2010 to aim for TSAT >30% unless serum ferritin levels were >1200 ng/mL. Data from only those patients who had been on dialysis for the whole duration between June 2009 and May 2011 were included. A total of 140 patients with end-stage renal disease on hemodialysis patients were found to be eligible for the study. There was a statistically significant increase in the mean TSAT and mean serum ferritin with the new anemia management protocol with a significant decrease in the mean erythropoiesis stimulating agent dose requirement. There was no statistically significant increase in the incidence of infectious complications. Although in vitro effects of iron are known to stimulate bacterial growth, a higher IV dose of iron may not increase the risk of infection in such patients.
为了治疗与终末期肾病相关的贫血，人们正在尝试各种策略来实现最佳的血红蛋白水平和较低的促红细胞生成素刺激剂剂量。其中一种方法涉及使用高剂量（转铁蛋白饱和度 (TSAT) >30%）的静脉 (IV) 铁补充剂。然而，由于铁在体外对刺激细菌生长的影响，人们担心感染风险增加。关于更高的铁靶目标与感染并发症（菌血症、肺炎、软组织感染和骨髓炎）的安全性尚不清楚。这是一项针对来自单一城市透析中心的维持性血液透析患者的回顾性研究，旨在评估更高的累积 IV 铁使用量对临床重要感染发生率的长期影响。我们的铁方案于 2010 年 6 月进行了修改，目的是使 TSAT >30%，除非血清铁蛋白水平>1200ng/mL。仅纳入了在 2009 年 6 月至 2011 年 5 月期间一直进行透析的患者的数据。发现 140 名终末期肾病血液透析患者符合研究条件。采用新的贫血管理方案后，平均 TSAT 和平均血清铁蛋白呈统计学显著增加，促红细胞生成素刺激剂剂量需求呈显著下降。感染并发症的发生率没有统计学显著增加。尽管已知铁的体外作用会刺激细菌生长，但更高剂量的 IV 铁可能不会增加此类患者的感染风险。
