常规低剂量静脉铁剂治疗可改善血液透析患者对促红细胞生成素的反应。

Regular low-dose intravenous iron therapy improves response to erythropoietin in haemodialysis patients.

作者信息

Taylor J E, Peat N, Porter C, Morgan A G

机构信息

Renal Unit, Nottingham City Hospital, Nottingham, UK.

出版信息

Nephrol Dial Transplant. 1996 Jun;11(6):1079-83.

PMID:8671972

Abstract

BACKGROUND

Erythropoietin (Epo) is an effective but expensive treatment for anaemia in patients with chronic renal failure. Hyporesponsiveness to Epo, particularly in haemodialysis patients, is most commonly due to a functional iron deficiency, which is difficult to monitor reliably.

METHODS

Forty-six stable haemodialysis patients, receiving Epo therapy, were commenced on regular low-dose intravenous iron (sodium ferric gluconate complex) at a dose of 62.5 mg/5 ml given as a slow injection post-dialysis twice weekly, weekly, or fortnightly, according to their serum ferritin levels. Haemoglobin, serum ferritin, Epo dose, and iron dose were measured at 6-weekly intervals over a 6-month period.

RESULTS

At the beginning of the study, 12 patients in the group had ferritin levels of less than 100 microg/l, and were thus considered to potentially have an absolute iron deficiency. The study group was therefore split into two subgroups for the purpose of analysis, i.e. the 12 patients with ferritin levels of less than 100 microg/l at the start of the study or 'low ferritin group', and the remaining 34 patients with ferritin levels of greater than 100 microg/l at the start of the study or 'normal ferritin group'. In the low ferritin group (n=12), intravenous iron therapy increased serum ferritin levels, and produced a significant rise in haemoglobin, and a significant reduction in Epo dose. (Ferritin pre-iron, median (range) 68 (20-96) microg/l; post-iron, 210.5 (91-447) microg/l, P<0. 003, Wilcoxon. Haemoglobin pre-iron, 10.05 (8.2-11.9) g/dl; post-iron, 11.0 (9.9-11.9) g/dl, P<0.03. Epo dose pre-iron, 9000 (4000-30 000)-i.u./week, P<0.05). Similar results were obtained in the normal ferritin group (n=34) following intravenous iron therapy, with significant increases in serum ferritin levels and haemoglobin concentrations, and a significant reduction in Epo dose. (Ferritin pre-iron, 176 (103-519) microg/l; post-iron, 304.5 (121-792) microg/l, P<0.0001. Haemoglobin pre-iron, 9.85 (6.5-12.8) g/dl; post-iron: 11.25 (9.9-13.3) g/dl, P<0.0001. Epo dose pre-iron, 6000 (2000-15 000) i.u./week; post-iron, 4000 (0-15 000)-i.u./week, P<0. 005).

CONCLUSION

Regular intravenous iron supplementation in haemodialysis patients improves the response to Epo therapy.

摘要

背景

促红细胞生成素（Epo）是治疗慢性肾衰竭患者贫血的一种有效但昂贵的疗法。对Epo反应低下，尤其是在血液透析患者中，最常见的原因是功能性铁缺乏，而这很难可靠地监测。

方法

46例接受Epo治疗的稳定血液透析患者，根据其血清铁蛋白水平，开始接受常规低剂量静脉注射铁剂（葡萄糖酸铁钠复合物），剂量为62.5mg/5ml，在透析后缓慢注射，每周两次、每周一次或每两周一次。在6个月的时间里，每隔6周测量血红蛋白、血清铁蛋白、Epo剂量和铁剂量。

结果

在研究开始时，该组中有12例患者的铁蛋白水平低于100μg/l，因此被认为可能存在绝对铁缺乏。因此，为了分析目的，将研究组分为两个亚组，即研究开始时铁蛋白水平低于100μg/l的12例患者或“低铁蛋白组”，以及研究开始时铁蛋白水平高于100μg/l的其余34例患者或“正常铁蛋白组”。在低铁蛋白组（n = 12）中，静脉注射铁剂治疗可提高血清铁蛋白水平，使血红蛋白显著升高，并使Epo剂量显著降低。（补铁前铁蛋白，中位数（范围）68（20 - 96）μg/l；补铁后，210.5（91 - 447）μg/l，P < 0.003，Wilcoxon检验。补铁前血红蛋白，10.05（8.2 - 11.9）g/dl；补铁后，11.0（9.9 - 11.9）g/dl，P < 0.03。补铁前Epo剂量，9000（4000 - 30000）国际单位/周，P < 0.05）。静脉注射铁剂治疗后，正常铁蛋白组（n = 34）也获得了类似结果，血清铁蛋白水平和血红蛋白浓度显著升高，Epo剂量显著降低。（补铁前铁蛋白，176（103 - 519）μg/l；补铁后，304.5（121 - 792）μg/l，P < 0.0001。补铁前血红蛋白，9.85（6.5 - 12.8）g/dl；补铁后：11.25（9.9 - 13.3）g/dl，P < 0.0001。补铁前Epo剂量，6000（2000 - 15000）国际单位/周；补铁后，4000（0 - 15000）国际单位/周，P < 0.005）。