Silverberg D S, Iaina A, Peer G, Kaplan E, Levi B A, Frank N, Steinbruch S, Blum M
Department of Nephrology, Ichilov Hospital, Tel Aviv, Israel.
Am J Kidney Dis. 1996 Feb;27(2):234-8. doi: 10.1016/s0272-6386(96)90546-6.
Iron deficiency may develop in hemodialysis patients, especially when erythropoietin is given. The role of iron deficiency in the anemia of predialysis chronic renal failure (CRF), however, is much less clear. We have intravenously (IV) administered iron as ferric saccharate in a total dose of 200 mg elemental iron monthly for 5 months to 33 CRF patients who remained anemic despite oral iron supplementation and who had no laboratory signs of iron overload. None was receiving erythropoietin therapy. In 22 of the patients there was an increase in the hematocrit values by the end of the study. These patients were considered responders to intravenous iron (IV Fe) therapy. In 11 patients the iron administration was not associated with improvement of the anemia (nonresponders). Before onset of the IV Fe therapy there were no differences between the responders and nonresponders with regard to degree of anemia, serum ferritin, iron saturation, renal function, or blood pressure. One additional patient was excluded from the study because of a mild reaction during an IV test dose before the study. No worsening of kidney function and no other side effects were noted. In four patients (three responders and one nonresponder) the control of blood pressure necessitated antihypertensive drug therapy adjustment. In conclusion, IV Fe supplementation in two thirds of anemic CRF patients not receiving dialysis resulted in a significant improvement of the anemia, thus avoiding the necessity of erythropoietin or blood administration. This could be achieved by increasing the plasma ferritin levels to 200 to 400 microns/L and/or increasing the iron saturation to 25% to 35%. Intravenous ferric saccharate appears to be a safe and effective method of administering iron for the correction of anemia in CRF patients not receiving dialysis.
缺铁可能在血液透析患者中出现，尤其是在使用促红细胞生成素时。然而，缺铁在透析前慢性肾衰竭（CRF）贫血中的作用尚不清楚得多。我们对33例CRF患者每月静脉注射（IV）蔗糖铁，总剂量为200mg元素铁，持续5个月，这些患者尽管口服补铁但仍贫血，且无铁过载的实验室迹象。无一例接受促红细胞生成素治疗。到研究结束时，22例患者的血细胞比容值有所增加。这些患者被认为是静脉铁（IV Fe）治疗的反应者。11例患者补铁与贫血改善无关（无反应者）。在IV Fe治疗开始前，反应者和无反应者在贫血程度、血清铁蛋白、铁饱和度、肾功能或血压方面无差异。另有一名患者因研究前IV试验剂量期间出现轻度反应而被排除在研究之外。未观察到肾功能恶化和其他副作用。4例患者（3例反应者和1例无反应者）需要调整抗高血压药物治疗以控制血压。总之，在三分之二未接受透析的贫血CRF患者中补充IV Fe可显著改善贫血，从而避免了使用促红细胞生成素或输血的必要性。这可以通过将血浆铁蛋白水平提高到200至400微克/升和/或将铁饱和度提高到25%至35%来实现。静脉注射蔗糖铁似乎是一种安全有效的给铁方法，用于纠正未接受透析的CRF患者的贫血。
