Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan School of Medicine, Tzu Chi University, Hualien, Taiwan.
Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
Nephrol Dial Transplant. 2015 Sep;30(9):1518-25. doi: 10.1093/ndt/gfv085. Epub 2015 Mar 31.
A risk/benefit analysis of iron supplementation in pre-dialysis advanced chronic kidney disease (CKD) patients has not been conducted. We aim to assess the effectiveness and the safety of iron supplementation in patients with CKD Stage 5 who have not yet received dialysis (CKD 5 ND).
A prospective cohort study was conducted based on the Taiwan National Health Insurance Research Database. From 1 January 2000 to 30 June 2009, we enrolled 31 971 adult patients who had a serum creatinine >6 mg/dL and a haematocrit <28% and who were treated with erythropoiesis-stimulating agents (ESAs). All patients were further divided into two groups with or without iron supplementation within 90 days after starting ESA therapy. Patient follow-up took place until dialysis, death before initiation of dialysis or 31 December 2009. The primary outcomes were death before initiating dialysis, hospitalization before death or long-term dialysis.
After propensity score matching, the patients who received iron supplementation were associated with a lower risk of all-cause death [hazard ratio (HR), 0.85; 95% confidence interval (CI), 0.80-0.90] compared with non-users. The survival benefit of iron use was consistent across the majority of dosage groups, except for those who were treated with monthly IV iron >200 mg. Moreover, compared with the non-users, the iron users were associated with a lower risk of hospitalizations (HR, 0.97; 95% CI, 0.94-0.99) but with a higher risk of faster progression to end-stage renal disease (HR, 1.05; 95% CI, 1.01-1.08).
Iron supplementation is associated with 15% risk reduction in death among CKD 5 ND patients who received ESA treatment. Randomized studies are needed to validate this association.
尚未接受透析的晚期慢性肾脏病（CKD）患者的铁补充的风险/获益分析尚未进行。我们旨在评估未接受透析（CKD 5 ND）的 CKD 5 期患者中补充铁的有效性和安全性。
我们进行了一项基于台湾全民健康保险研究数据库的前瞻性队列研究。从 2000 年 1 月 1 日至 2009 年 6 月 30 日，我们纳入了 31971 名血清肌酐>6mg/dL 和血细胞比容<28%且接受促红细胞生成素刺激剂（ESA）治疗的成年患者。所有患者进一步分为 ESA 治疗开始后 90 天内有无铁补充的两组。患者随访至透析、透析前死亡或 2009 年 12 月 31 日。主要结局为透析前死亡、死亡前住院或长期透析。
经过倾向评分匹配后，与未使用者相比，接受铁补充的患者全因死亡风险较低[风险比（HR），0.85；95%置信区间（CI），0.80-0.90]。铁的使用对生存有益，在大多数剂量组中都是如此，除了每月静脉注射铁>200mg 的患者。此外，与未使用者相比，铁使用者的住院风险较低（HR，0.97；95%CI，0.94-0.99），但进展为终末期肾病的风险较高（HR，1.05；95%CI，1.01-1.08）。
在接受 ESA 治疗的 CKD 5 ND 患者中，铁补充与死亡风险降低 15%相关。需要进行随机研究来验证这种关联。
