Sunder-Plassmann G, Hörl W H
Department of Medicine, University of Vienna, Austria.
Clin Nephrol. 1997 Mar;47(3):141-57.
Careful evaluation of iron status is of pivotal importance in end-stage renal disease patients before and during r-HuEPO therapy. Absolute (ferritin < 100 micrograms/l) and functional (ferritin normal or supranormal, transferrin saturation < 20%, hypochromic red blood cell [RBC] > 5%) iron deficiency are the main reasons for r-HuEPO hyporesponsiveness. Adequate iron supplementation allows significant reduction of r-HuEPO dosage and costs. Oral iron supplementation is recommended for predialysis and peritoneal dialysis patients with serum ferritin > 100 micrograms/l, whereas i.v. iron supplementation is the therapy of choice in hemodialysis patients. However, neutrophil impairment and other possible side-effects (e.g. cardiovascular complications, malignancy) as a result of i.v. iron therapy suggest that overtreatment with i.v. iron should be avoided.
在终末期肾病患者接受重组人促红细胞生成素（r-HuEPO）治疗之前及治疗期间，仔细评估铁状态至关重要。绝对铁缺乏（铁蛋白<100微克/升）和功能性铁缺乏（铁蛋白正常或高于正常，转铁蛋白饱和度<20%，低色素红细胞[RBC]>5%）是r-HuEPO反应低下的主要原因。充足的铁补充可显著降低r-HuEPO剂量和成本。对于血清铁蛋白>100微克/升的血液透析前和腹膜透析患者，建议口服铁补充剂，而静脉注射铁补充剂是血液透析患者的首选治疗方法。然而，静脉注射铁治疗导致的中性粒细胞损伤和其他可能的副作用（如心血管并发症、恶性肿瘤）表明，应避免静脉注射铁的过度治疗。
