Renal Associates PA, San Antonio, TX.
Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY.
Adv Chronic Kidney Dis. 2019 Jul;26(4):272-291. doi: 10.1053/j.ackd.2019.05.002.
Iron deficiency anemia (IDA) is a frequent complication of chronic kidney disease (CKD) and is associated with adverse outcomes in these patients. Patients with CKD and IDA remain largely undertreated. Conventional oral iron agents are insufficiently effective due to poor absorption and cause gastrointestinal side effects; thus, novel oral iron preparations are needed. This article covers current treatment guidelines for patients with anemia and CKD and clinical trial data for iron-repletion agents currently in use, as well as for novel oral iron therapies in development. Ferric citrate, a novel oral iron-repletion agent approved for patients with non-dialysis-dependent CKD and IDA, demonstrated improvements in hemoglobin levels and iron parameters, with good tolerability in patients with non-dialysis-dependent CKD. When used as a phosphate binder, ferric citrate also improves hemoglobin and iron parameters in dialysis-dependent CKD, but additional trials are needed to evaluate its efficacy as an iron-repletion agent in this setting. Other novel oral iron preparations in development for IDA in patients with CKD include ferric maltol, which is approved in Europe and the United States for IDA in adult patients, and sucrosomial iron, which has been evaluated in IDA associated with CKD and several other clinical settings.
缺铁性贫血（IDA）是慢性肾脏病（CKD）的常见并发症，与这些患者的不良结局相关。CKD 和 IDA 患者的治疗仍严重不足。由于吸收不良和引起胃肠道副作用，传统的口服铁剂效果不佳；因此，需要新型口服铁剂。本文涵盖了目前用于贫血和 CKD 患者的治疗指南，以及目前正在使用的铁补充剂和正在开发的新型口服铁治疗的临床试验数据。柠檬酸铁，一种新型口服铁补充剂，已被批准用于非透析依赖性 CKD 和 IDA 患者，可改善血红蛋白水平和铁参数，在非透析依赖性 CKD 患者中具有良好的耐受性。当用作磷酸盐结合剂时，柠檬酸铁也可改善透析依赖性 CKD 患者的血红蛋白和铁参数，但需要进一步的试验来评估其在该环境下作为铁补充剂的疗效。其他正在开发用于 CKD 患者 IDA 的新型口服铁制剂包括柠檬酸铁麦芽酚，已在欧洲和美国批准用于成年 IDA 患者，以及蔗糖铁，已在 CKD 相关 IDA 和其他几种临床环境中进行了评估。
