Malkinska Marta, El Nekidy Wasim S, El-Masri Maher M, Kadri Albert, Donaldson Christine, Soong Derrick
BSc, BScPhm, ACPR, is with the Department of Nephrology, Sunnybrook Health Sciences Centre, Toronto, Ontario.
PharmD, BCPS, BCACP, is with the Department of Nephrology and the Department of Pharmacy, Windsor Regional Hospital, Windsor, Ontario.
Can J Hosp Pharm. 2015 Jul-Aug;68(4):304-10.
Although parenteral iron replacement is a key aspect of managing anemia in patients who are undergoing hemodialysis, studies evaluating novel iron dosing regimens are scarce.
To compare the effectiveness of a once-weekly IV iron dosing strategy with that of a conventional accelerated iron dosing regimen in patients undergoing hemodialysis.
In this retrospective cohort study, patient-specific information was collected for individuals undergoing hemodialysis who received IV iron between June 1, 2010, and June 30, 2012, at a community hospital in southwestern Ontario. The primary outcomes were hemoglobin level and utilization of an erythropoiesis-stimulating agent for 2 groups of patients: those receiving iron according to a once-weekly IV regimen and those receiving iron by a conventional accelerated IV regimen.
Of the 148 patients who met the inclusion criteria, 99 (66.9%) received iron by a conventional accelerated regimen and 49 (33.1%) by a once-weekly IV regimen. Generalized estimating equations developed from 313 observations obtained from these 148 patients suggested that average transferrin saturation percentage and iron concentration were both significantly higher in the group that received iron once weekly than in the group that received iron by the conventional accelerated regimen (p = 0.014 and 0.008, respectively). The mean weekly dose of erythropoiesis-stimulating agent was significantly lower in the once-weekly administration group than in the conventional administration group (7419 versus 10 706 units; p = 0.041). The 2 groups did not differ significantly in terms of hemoglobin concentration (p = 0.46) or ferritin level (p = 0.13).
The findings of this study suggest that a once-weekly iron dosing regimen may be superior to a conventional accelerated dosing regimen for managing iron deficiency anemia in patients who are undergoing hemodialysis.
尽管胃肠外铁剂补充是治疗正在接受血液透析患者贫血的关键环节，但评估新型铁剂给药方案的研究却很匮乏。
比较每周一次静脉注射铁剂给药策略与传统加速铁剂给药方案在接受血液透析患者中的有效性。
在这项回顾性队列研究中，收集了2010年6月1日至2012年6月30日期间在安大略省西南部一家社区医院接受静脉注射铁剂的血液透析患者的个体特定信息。主要结局是两组患者的血红蛋白水平和促红细胞生成素的使用情况：一组按照每周一次静脉给药方案接受铁剂治疗，另一组按照传统加速静脉给药方案接受铁剂治疗。
在符合纳入标准的148例患者中，99例（66.9%）接受传统加速给药方案的铁剂治疗，49例（33.1%）接受每周一次静脉给药方案的铁剂治疗。从这148例患者获得的313次观察结果得出的广义估计方程表明，每周接受一次铁剂治疗的组的平均转铁蛋白饱和度百分比和铁浓度均显著高于接受传统加速给药方案的组（分别为p = 0.014和0.008）。每周一次给药组促红细胞生成素的平均每周剂量显著低于传统给药组（7419单位对10706单位；p = 0.041）。两组在血红蛋白浓度（p = 0.46）或铁蛋白水平（p = 0.13）方面无显著差异。
本研究结果表明，对于正在接受血液透析的患者，每周一次铁剂给药方案在治疗缺铁性贫血方面可能优于传统加速给药方案。
