Sepandj F, Jindal K, West M, Hirsch D
Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Nephrol Dial Transplant. 1996 Feb;11(2):319-22. doi: 10.1093/oxfordjournals.ndt.a027260.
Iron deficiency is common in haemodialysis patients and adequate supplementation by the oral or parenteral route has been limited by drug side-effects, absorption, and cost. Intermittent doses of intravenous iron dextran complex are recommended in patients with inadequate iron stores despite maximal tolerated oral dose. We conducted a prospective study with economic analysis of a regular maintenance intravenous iron regimen in this group of patients.
Fifty patients comprising one-half of our haemodialysis population required intravenous iron treatment, i.e. they failed to achieve an arbitrary goal serum ferritin 100 microg/l despite maximal tolerated oral iron dose. After a loading dose of intravenous iron dextran complex (IV-FeD) based on Van Wyck's nomogram (400+/-300 mg) they received a maintenance dose of 100mg IV-FeD once every 2 weeks. Initial goal serum ferritin was set at 100-200 microg/l. If no increase in haemoglobin was achieved at this level, transferrin saturation was measured to assess bioavailable iron, and when less than 20%, goal serum ferritin was increased to 200-300 microg/l. Recombinant human erythropoietin (rHuEpo) was used where needed to maintain haemoglobin in the 9.5-10.5 g/l range only if ferritin requirements were met. Results. Mean haemoglobin rose from 87.7+/-12.1 to 100.3+/-13.1 g/l (P<0.001, Cl 7.7-17.9) at mean follow-up of 6 months (range 3-15 months). In patients on rHuEpo, dose per patient was reduced from 96+/-59 u/kg per week to 63+/-41 u/kg per week, representing a 35% dose reduction (P<0.05, Cl 1-65). An annual cost reduction of $3166 CDN was projected; however, in the first year this is offset by the cost of the loading dose of IV-FeD required at the beginning of treatment. No adverse reactions were encountered.
Iron deficiency is very common in our haemodialysis population, especially in those patients receiving rHuEpo. A carefully monitored regimen of maintenance parenteral iron is a safe, effective, and economically favourable means of iron supplementation in patients with insufficient iron stores on maximum tolerated oral supplements.
缺铁在血液透析患者中很常见，通过口服或肠外途径进行充分补充受到药物副作用、吸收和成本的限制。对于铁储备不足的患者，尽管口服剂量已达最大耐受量，仍推荐间歇性静脉注射右旋糖酐铁复合物。我们对这组患者的常规维持性静脉补铁方案进行了一项前瞻性经济分析研究。
50名患者占我们血液透析人群的一半，需要静脉补铁治疗，即尽管口服铁剂已达最大耐受量，但血清铁蛋白仍未达到100μg/L的任意目标值。根据范·怀克（Van Wyck）图表给予静脉注射右旋糖酐铁复合物（IV-FeD）负荷剂量（400±300mg）后，他们每2周接受100mg IV-FeD的维持剂量。初始目标血清铁蛋白设定为100 - 200μg/L。如果在此水平血红蛋白未升高，则测量转铁蛋白饱和度以评估生物可利用铁，当低于20%时，目标血清铁蛋白提高到200 - 300μg/L。仅在铁蛋白需求得到满足时，必要时使用重组人促红细胞生成素（rHuEpo）将血红蛋白维持在9.5 - 10.5g/L范围内。结果：在平均6个月（范围3 - 15个月）的随访中，平均血红蛋白从87.7±12.1g/L升至100.3±13.1g/L（P<0.001，可信区间7.7 - 17.9）。在接受rHuEpo的患者中，每位患者的剂量从每周96±59u/kg降至63±41u/kg，剂量降低了35%（P<0.05，可信区间1 - 65）。预计每年成本降低3166加元；然而，在第一年，这被治疗开始时所需的IV-FeD负荷剂量成本所抵消。未出现不良反应。
缺铁在我们的血液透析人群中非常常见，尤其是在接受rHuEpo的患者中。对于口服最大耐受补充剂后铁储备不足的患者，仔细监测的维持性肠外补铁方案是一种安全、有效且经济实惠的补铁方式。
