Nand Nitya, Giri Kajaree, Jain Deepak
Senior Professor & Head, Department of Medicine and Division of Nephrology, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana; *Corresponding Author.
Resident, Department of Medicine, Department of Medicine and Division of Nephrology, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana.
J Assoc Physicians India. 2019 Apr;67(4):53-56.
Disorders of mineral and bone metabolism in chronic kidney disease (CKD) are associated with increased risk for cardiovascular calcification and osteoporosis. Anemia has been associated with progressive loss of kidney function and increased mortality. Ferric citrate was recently developed, primarily as a novel oral, non-calcium phosphate binder, which has also shown to replenish the iron deficient state of the CKD patients.
This prospective study was done on 40 pre-dialysis adult patients of CKD (stage 3-5) from a tertiary care centre in North India. Patients on intravenous iron, erythropoietin stimulating agents or other phosphate binders were excluded from the study. All the patients were given tablet ferric citrate (each tablet containing ferric citrate 1.1 gm equivalent to ferric iron 210 mg) in a dose of 3 tablets per day for three months. Patients were followed up at two weekly intervals and relevant investigations were done. They were divided into three groups according to their CKD stages for subgroup analysis.
After three months of therapy with ferric citrate there was a significant decrease in mean serum phosphate from 6.55±0.70 mg/dl at baseline to 4.36±0.50 mg/dl at the end of three months (p<0.001). Mean hemoglobin increased from 7.92±1.05 g/dl at baseline to 10.96±1.04 g/dl at the end of three months (p<0.001). Serum ferritin and serum transferrin saturation increased from 278.25±110.56 ng/dl, 25.02±4.03 % at baseline to 401.24±152.47 ng/dl and 29.62±3.77 % at the end of three months. The mean serum vitamin D and serum iPTH levels, at baseline and at the end of 3 months were 14.61±10.80 ng/ml, 509.48±210.75 pg/ml and 23.65±14.00 ng/ml, 424.14±173.18 pg/ml respectively. The change in all these parameters were significant irrespective of the CKD stages.
The present study has shown that ferric citrate is an effective and well tolerated phosphate binder, which also significantly improves hematologic parameters in an iron deficient CKD patient.
慢性肾脏病（CKD）患者的矿物质和骨代谢紊乱与心血管钙化及骨质疏松风险增加相关。贫血与肾功能的进行性丧失及死亡率增加有关。柠檬酸铁是最近研发的，主要作为一种新型口服非钙磷结合剂，它也已显示可补充CKD患者的缺铁状态。
这项前瞻性研究针对来自印度北部一家三级医疗中心的40例成年CKD（3 - 5期）透析前患者进行。接受静脉铁剂、促红细胞生成素或其他磷结合剂治疗的患者被排除在研究之外。所有患者均给予柠檬酸铁片（每片含柠檬酸铁1.1克，相当于铁元素210毫克），剂量为每日3片，持续三个月。每两周对患者进行随访并进行相关检查。根据CKD分期将他们分为三组进行亚组分析。
使用柠檬酸铁治疗三个月后，平均血清磷从基线时的6.55±0.70毫克/分升降至三个月末的4.36±0.50毫克/分升，显著下降（p<0.001）。平均血红蛋白从基线时的7.92±1.05克/分升升至三个月末的10.96±1.04克/分升（p<0.001）。血清铁蛋白和血清转铁蛋白饱和度从基线时的278.25±110.56纳克/毫升、25.02±4.03%升至三个月末的401.24±152.47纳克/毫升和29.62±3.77%。基线时和三个月末的平均血清维生素D和血清全段甲状旁腺激素（iPTH）水平分别为14.61±10.80纳克/毫升、509.48±210.75皮克/毫升和23.65±14.00纳克/毫升、424.14±173.18皮克/毫升。无论CKD分期如何，所有这些参数的变化均具有显著性。
本研究表明，柠檬酸铁是一种有效且耐受性良好的磷结合剂，它还能显著改善缺铁性CKD患者的血液学参数。
