Wu Mei-Yi, Chen Ying-Chun, Lin Chun-Hung, Wu Yun-Chun, Tu Yu-Kang, Tarng Der-Cherng
Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Oncotarget. 2017 Oct 20;8(63):107283-107294. doi: 10.18632/oncotarget.21990. eCollection 2017 Dec 5.
Ferric citrate has been reported to have the potential to reduce phosphate and increase iron availability in patients with chronic kidney disease. In the present study, we evaluated its safety and efficacy in phosphate reduction and iron supplementation in chronic kidney disease stage 3-5 requiring dialysis patients. We systematically searched for clinical trials published in PubMed, Medline, and Cochrane databases. Only randomized controlled trials on the effects of ferric citrate in chronic kidney disease stage 3-5 requiring dialysis patients were selected. The primary outcomes were changes in serum phosphate, calcium, and anemia-related parameters. The secondary outcomes were the adverse effects of ferric citrate. Nine studies providing data on 1755 patients were included in the meta-analysis. Ferric citrate significantly reduced serum phosphate compared with placebo (mean difference, -1.39; 95% confidence interval, -2.12 to -0.66) and had a non-inferior effect compared with active treatment. Furthermore, ferric citrate significantly improved hemoglobin, transferrin saturation and ferritin. Adverse effects of constipation did not differ significantly between ferric citrate and placebo or active treatment. This review provides evidence that ferric citrate effectively alleviates hyperphosphatemia and iron deficiency in patients with chronic kidney disease stage 3-5 requiring dialysis patients. However, the included studies did not have cardiovascular complications or mortality information and could not assess whether ferric citrate affected the risk of all-cause death or cardiovascular complications in patients with chronic kidney disease. Further studies are required to assess whether the long-term use of ferric citrate can reduce the risk of cardiovascular events and all-cause mortality.
据报道，柠檬酸铁有潜力降低慢性肾病患者的磷酸盐水平并提高铁的利用率。在本研究中，我们评估了其在需要透析的3 - 5期慢性肾病患者中降低磷酸盐和补充铁的安全性及疗效。我们系统检索了发表在PubMed、Medline和Cochrane数据库中的临床试验。仅选择了关于柠檬酸铁对需要透析的3 - 5期慢性肾病患者影响的随机对照试验。主要结局为血清磷酸盐、钙及贫血相关参数的变化。次要结局为柠檬酸铁的不良反应。荟萃分析纳入了9项为1755例患者提供数据的研究。与安慰剂相比，柠檬酸铁显著降低了血清磷酸盐水平（平均差值，-1.39；95%置信区间，-2.12至-0.66），且与活性治疗相比具有非劣效性。此外，柠檬酸铁显著改善了血红蛋白、转铁蛋白饱和度和铁蛋白水平。柠檬酸铁与安慰剂或活性治疗之间便秘的不良反应无显著差异。本综述提供了证据表明，柠檬酸铁可有效缓解需要透析的3 - 5期慢性肾病患者的高磷血症和铁缺乏。然而，纳入的研究没有心血管并发症或死亡率信息，无法评估柠檬酸铁是否会影响慢性肾病患者的全因死亡风险或心血管并发症。需要进一步研究来评估长期使用柠檬酸铁是否能降低心血管事件风险和全因死亡率。
