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终末期肾病患者静脉注射铁剂的安全性问题

Safety aspects of parenteral iron in patients with end-stage renal disease.

作者信息

Sunder-Plassmann G, Hörl W H

机构信息

Department of Medicine, University of Vienna, Austria.

出版信息

Drug Saf. 1997 Oct;17(4):241-50. doi: 10.2165/00002018-199717040-00004.

Abstract

Absolute and functional iron deficiency is the most common cause of epoetin (recombinant human erythropoietin) hyporesponsiveness in renal failure patients. Diagnostic procedures for determining iron deficiency include measurement of serum iron levels, serum ferritin levels, saturation of transferrin and percentage of hypochromic red blood cells. Patients with iron deficiency should receive supplemental iron, either orally or intravenously. Adequate intravenous iron supplementation allows reduction of epoetin dosage by approximately 40%. Intravenous iron supplementation is recommended for all patients undergoing haemodialysis and for pre-dialysis and peritoneal dialysis patients with severe iron deficiency. During the maintenance phase (period of epoetin therapy after correction of iron deficiency), the use of low-dose intravenous iron supplementation (10 to 20 mg per haemodialysis treatment or 100 mg every second week) avoids iron overtreatment and minimises potential adverse effects. Depending on the degree of pre-existing iron deficiency, markedly higher iron doses are necessary during the correction phase (period of epoetin therapy after correction of iron deficiency) [e.g. intravenous iron 40 to 100 mg per haemodialysis session up to a total dose of 1000 mg]. The iron status should be monitored monthly during the correction phase and every 3 months during the maintenance phase to avoid overtreatment with intravenous iron.

摘要

绝对铁缺乏和功能性铁缺乏是肾衰竭患者促红细胞生成素(重组人促红细胞生成素)低反应性的最常见原因。确定铁缺乏的诊断方法包括测量血清铁水平、血清铁蛋白水平、转铁蛋白饱和度和低色素红细胞百分比。缺铁患者应接受口服或静脉补铁。充足的静脉补铁可使促红细胞生成素剂量减少约40%。建议所有接受血液透析的患者以及严重缺铁的透析前和腹膜透析患者进行静脉补铁。在维持阶段(缺铁纠正后的促红细胞生成素治疗期),使用低剂量静脉补铁(每次血液透析治疗10至20毫克或每两周100毫克)可避免铁过量治疗并将潜在不良反应降至最低。根据既往缺铁的程度,在纠正阶段(缺铁纠正后的促红细胞生成素治疗期)需要明显更高的铁剂量[例如,每次血液透析静脉补铁40至100毫克,直至总剂量达到1000毫克]。在纠正阶段应每月监测铁状态,在维持阶段每3个月监测一次,以避免静脉补铁过量治疗。

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