Roldão Marisa, Escoli Rachele, Gonçalves Hernâni, Lobos Ana Vila
Department of Nephrology, Centro Hospitalar do Médio Tejo, Av. Xanana Gusmão 45, 2350-754, Torres Novas, Portugal.
Int Urol Nephrol. 2023 Apr;55(4):953-959. doi: 10.1007/s11255-022-03360-9. Epub 2022 Sep 29.
Iron deficiency anemia occurs in most patients with non-dialysis chronic kidney disease (ND-CKD). Previous studies have suggested that intravenous (IV) iron therapy is more effective than oral iron in these patients. Clinical evidence relating the effects of IV iron on renal function is, however, limited.
Prospective observational study of adult patients with ND-CKD, anemia, iron deficiency, and estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m, treated with a single dose of 500 mg or 1000 mg of ferric carboxymaltose (FCM) and followed-up for 24 weeks. Primary outcome was FCM efficacy, assessed by comparing Hb, TSAT and ferritin at 24 weeks with those at baseline. Secondary outcome was FCM impact on renal function, evaluated by comparing eGFR over the same period.
One hundred and forty patients were recruited: seventy-eight (55.7%) were treated with 1000 mg and 62 (44.3%) with 500 mg of FCM. 24 weeks after FCM administration, Hb increased 1.54 ± 1.99 g/dL (95% CI 1.09-1.99, p = 001) in the group treated with 1000 mg and 0.86 ± 1.4 g/dL (95% CI 0.53-1.22, p = 0.001) in those treated with 500 mg. TSAT increased in both groups but more in those treated with 1000 mg, and ferritin only increased in the latter. Estimated GFR showed a significant increase of 1.55 ± 6.86 mL/min/m (95% CI 0.05-3.09, p = 0.049), from a baseline of 27.73 ± 17.23 to 28.88 ± 18.02 mL/min/m in the group treated with 1000 mg.
Our findings suggested that IV FCM therapy was effective in improving serum iron levels and anemia in ND-CKD stage 3 to 5 patients. Higher doses seem to be necessary to replace depleted iron stores. In our cohort, IV FCM therapy was associated with an improvement in renal function, particularly in those treated with higher doses of FCM.
大多数非透析慢性肾脏病（ND-CKD）患者会发生缺铁性贫血。既往研究表明，对于这些患者，静脉注射铁剂治疗比口服铁剂更有效。然而，关于静脉注射铁剂对肾功能影响的临床证据有限。
对成年ND-CKD、贫血、缺铁且估计肾小球滤过率（eGFR）<60 mL/min/1.73 m²的患者进行前瞻性观察研究，给予单次剂量500 mg或1000 mg的羧麦芽糖铁（FCM）治疗，并随访24周。主要结局是FCM的疗效，通过比较24周时的血红蛋白（Hb）、转铁蛋白饱和度（TSAT）和铁蛋白与基线水平来评估。次要结局是FCM对肾功能的影响，通过比较同一时期的eGFR来评估。
共招募了140例患者：78例（55.7%）接受1000 mg FCM治疗，62例（44.3%）接受500 mg FCM治疗。FCM给药24周后，接受1000 mg治疗组的Hb升高1.54±1.99 g/dL（95%CI 1.09 - 1.99，p = 0.001），接受500 mg治疗组的Hb升高0.86±1.4 g/dL（95%CI 0.53 - 1.22，p = 0.001）。两组的TSAT均升高，但接受1000 mg治疗组升高更多，且铁蛋白仅在接受1000 mg治疗组中升高。接受1000 mg治疗组的估计GFR从基线的27.73±17.23显著升高至28.88±18.02 mL/min/m²，升高了1.55±6.86 mL/min/m²（95%CI 0.05 - 3.09，p = 0.049）。
我们的研究结果表明，静脉注射FCM治疗对于改善3至5期ND-CKD患者的血清铁水平和贫血有效。似乎需要更高剂量来补充耗尽的铁储备。在我们的队列中，静脉注射FCM治疗与肾功能改善相关，尤其是在接受更高剂量FCM治疗的患者中。
