Drüeke T B, Bárány P, Cazzola M, Eschbach J W, Grützmacher P, Kaltwasser J P, Macdougall I C, Pippard M J, Shaldon S, van Wyck D
Hôpital Necker, Paris, France.
Clin Nephrol. 1997 Jul;48(1):1-8.
Much progress has been made in recent years in the management of anemia associated with chronic and renal failure with recombinant human erythropoietin (r-Hu EPO). However, there remains much debate surrounding the diagnosis and treatment of iron deficiency. To ensure that full benefit from erythropoietin therapy is received, most patients require iron supplement during treatment. There are, however, few guidelines for the use of iron therapy. Iron deficiency results in an inadequate response to r-Hu EPO and is the main cause of resistance to this treatment. Oral iron therapy is of limited value in patients receiving r-Hu EPO. Thus, intravenous iron supplementation should be administered only in patients who do not tolerate available intravenous iron preparations or who are on continuous ambulatory peritoneal dialysis with no evidence of functional iron deficiency. This article provides guidelines for the diagnosis of absolute or functional iron deficiency in patients with renal anemia and suggests treatment schedules for intravenous iron supplementation. We hope that all dialysis patients will be able on this basis to achieve a satisfactory iron status and benefit fully from r-Hu EPO therapy.
近年来，重组人促红细胞生成素（r-Hu EPO）在慢性肾衰竭相关贫血的治疗方面取得了很大进展。然而，围绕缺铁的诊断和治疗仍存在很多争议。为确保从促红细胞生成素治疗中获得充分益处，大多数患者在治疗期间需要补充铁剂。然而，关于铁剂治疗的使用指南却很少。缺铁会导致对r-Hu EPO反应不足，是这种治疗耐药的主要原因。口服铁剂治疗对接受r-Hu EPO的患者价值有限。因此，静脉补铁仅应给予那些不耐受现有静脉铁剂制剂的患者，或正在进行持续性非卧床腹膜透析且无功能性缺铁证据的患者。本文提供了肾性贫血患者绝对或功能性缺铁的诊断指南，并建议了静脉补铁的治疗方案。我们希望所有透析患者在此基础上都能达到满意的铁状态，并从r-Hu EPO治疗中充分获益。
