Iron therapy in chronic kidney disease: Recent changes, benefits and risks

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• 作者：Sandra Ribeiro^a ; ¹ ; ^{sandra.ribeiro870@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Luí ; s Belo^a ; ² ; ^{luisbelo@ff.up.pt" class="auth_mail" title="E-mail the corresponding author} ; Flá ; vio Reis^b ; ^c ; ³ ; ^{freis@fmed.uc.pt" class="auth_mail" title="E-mail the corresponding author} ; Alice Santos-Silva^a ; ^{assilva@ff.up.pt" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Anemia ; Chronic kidney disease ; Hemodialysis ; Intravenous iron ; Iron therapy ; Iron overload ; Mortality
• 刊名：Blood Reviews
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：30
• 期：1
• 页码：65-72
• 全文大小：557 K

文摘

Anemia is a common complication in patients with chronic kidney disease (CKD), mainly due to inadequate renal production of erythropoietin. In hemodialysis (HD) patients this condition may be aggravated by iron deficiency (absolute or functional). The correction of this anemia is usually achieved by treatment with erythropoiesis stimulating agents (ESAs) and iron (oral or intravenous). Studies questioning the safety of ESAs (especially at higher doses) changed the pattern of anemia treatment in CKD patients. According to the new guidelines, when transferrin saturation is lower than 30% and ferritin lower than 500 ng/mL, a trial with iron should be started, to avoid therapy with ESAs or at least to reduce the doses needed to treat the anemia. Recent reports showed increasing ferritin levels, towards values above 800 ng/mL, in CKD patients treated according to the guidelines. In this review we focus on the risks of the increased iron use to treat CKD anemia, namely, iron overload and toxicity, increased risk of infections, as well as mortality.