Brunet Philippe, Choukroun Gabriel, Moulin Bruno, Zaoui Philippe, Thervet Éric, Frimat Luc, Chazot Charles
Centre de néphrologie et de transplantation rénale, hôpital de la Conception, APHM, 147 boulevard Baille, 13005 Marseille, France.
Service de néphrologie, médecine interne, dialyse, transplantation, CHU Amiens-Picardie, 80054 Amiens, France.
Nephrol Ther. 2020 May;16(3):153-157. doi: 10.1016/j.nephro.2019.10.002. Epub 2020 May 11.
The French-speaking Society of Nephrology, Dialysis and Transplantation conducted, in 2018, a survey among French nephrologists into their iron prescribing habits for patients with chronic kidney disease stages 3 to 5 before dialysis. The results show that 73% of nephrologists use intravenous iron before dialysis stage. When a patient has gastrointestinal symptoms under oral iron therapy, only 48% of nephrologists use intravenous route. The starting thresholds for iron are for 78% of nephrologists a transferrin saturation <20% and for 80% a serum ferritin <100 μg/L. Only 14% start iron when a transferrin saturation <25% or higher and 29% start iron when serum ferritin <200 μg/L or higher. High dosages of iron (500 and 1000 mg) are used by 58% of nephrologists. Finally, about 30% of nephrologists refer to various barriers to intravenous iron prescription, such as cost, unavailability of intravenous iron in their facility or lack of day hospital unit. The correction of iron deficiency without anemia remains controversial. It is performed by only 43% of nephrologists. These results show an improvement of the practices compared to a 2006 survey. However, they indicate a sub-prescription of iron compared to the European recommendations which recommend a starting threshold of iron of transferrin saturation <25% and ferritinemia <200 μg/L in anemic patients not treated with erythropoietin-stimulating agents.
法语国家肾脏病、透析与移植学会于2018年对法国肾脏病医生进行了一项调查，了解他们针对透析前慢性肾脏病3至5期患者的铁剂处方习惯。结果显示，73%的肾脏病医生在透析阶段前使用静脉铁剂。当患者在口服铁剂治疗期间出现胃肠道症状时，只有48%的肾脏病医生使用静脉途径。对于78%的肾脏病医生来说，铁剂的起始阈值是转铁蛋白饱和度<20%，对于80%的医生来说是血清铁蛋白<100μg/L。只有14%的医生在转铁蛋白饱和度<25%或更高时开始使用铁剂，29%的医生在血清铁蛋白<200μg/L或更高时开始使用铁剂。58%的肾脏病医生使用高剂量铁剂（500和1000mg）。最后，约30%的肾脏病医生提到了静脉铁剂处方的各种障碍，如成本、其所在机构静脉铁剂供应不足或缺乏日间医院病房。无贫血的缺铁纠正仍存在争议。只有43%的肾脏病医生进行此项操作。这些结果表明与2006年的一项调查相比，实践有所改善。然而，与欧洲建议相比，它们表明铁剂处方不足，欧洲建议在未接受促红细胞生成素刺激剂治疗的贫血患者中，铁剂的起始阈值为转铁蛋白饱和度<25%和铁蛋白血症<200μg/L。
