Fishbane S, Frei G L, Maesaka J
Division of Nephrology, Winthrop-University Hospital, Mineola, NY, USA.
Am J Kidney Dis. 1995 Jul;26(1):41-6. doi: 10.1016/0272-6386(95)90151-5.
We have compared the efficacy of oral to intravenous iron for the chronic maintenance of iron stores in hemodialysis patients. Fifty-two hemodialysis patients with initial serum ferritin greater than 100 ng/mL and transferrin saturation greater than 15% were randomly assigned to one of two groups: those receiving oral iron therapy (n = 32) and those receiving intravenous iron dextran (100 mg twice weekly) (n = 20). At study completion (4 months), the mean hematocrit was significantly higher in the intravenous group than in the oral iron group (34.4% +/- 0.7% v 31.8% +/- 0.4%, respectively; P < 0.05), the final mean recombinant human erythropoietin dose was 46% lower in the intravenous iron group than in the oral group (4,050 +/- 634 U/treatment v 7,563 +/- 378 U/treatment; P < 0.05), and the mean serum ferritin was significantly higher in the intravenous group than in the oral iron group (753.9 +/- 30.2 ng/mL v 157.3 +/- 15.4 ng/mL, respectively; P < 0.05). We have found that administering iron intravenously instead of orally for chronic maintenance iron supplementation in hemodialysis patients resulted in improved erythropoiesis. We hypothesize that most hemodialysis patients have inadequate iron stores for optimal erythropoiesis when currently recommended levels of ferritin and transferrin saturation are used to guide therapy, and that the chronic use of intravenous iron could reduce recombinant human erythropoietin requirements by maximizing iron stores. The improvement in erythropoiesis was accompanied, however, by an increase in iron indices to levels that could be indicative of tissue iron overload. Future studies must be performed to determine whether lower doses of intravenous iron dextran would improve erythropoiesis without causing potential organ iron overload.
我们比较了口服铁剂与静脉注射铁剂在维持血液透析患者铁储备方面的疗效。52例初始血清铁蛋白大于100 ng/mL且转铁蛋白饱和度大于15%的血液透析患者被随机分为两组：一组接受口服铁剂治疗（n = 32），另一组接受静脉注射右旋糖酐铁（每周两次，每次100 mg）（n = 20）。在研究结束时（4个月），静脉注射组的平均血细胞比容显著高于口服铁剂组（分别为34.4%±0.7%和31.8%±0.4%；P < 0.05），静脉注射铁剂组的最终重组人促红细胞生成素平均剂量比口服组低46%（4050±634 U/次 vs 7563±378 U/次；P < 0.05），静脉注射组的平均血清铁蛋白显著高于口服铁剂组（分别为753.9±30.2 ng/mL和157.3±15.4 ng/mL；P < 0.05）。我们发现，在血液透析患者中，静脉注射铁剂而非口服铁剂进行慢性维持性铁补充可改善红细胞生成。我们推测，当目前推荐的铁蛋白和转铁蛋白饱和度水平用于指导治疗时，大多数血液透析患者的铁储备不足以实现最佳红细胞生成，而长期使用静脉注射铁剂可通过使铁储备最大化来降低重组人促红细胞生成素的需求量。然而，红细胞生成的改善伴随着铁指标升高至可能表明组织铁过载的水平。必须开展进一步研究以确定较低剂量的静脉注射右旋糖酐铁是否能在不引起潜在器官铁过载的情况下改善红细胞生成。
