Diagnosis and Management of Iron Deficiency in CKD: A Summary of the NICE Guideline Recommendations and Their Rationale

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• 作者：Laura E.K. Ratcliffe ; MRCP¹ ; Wayne Thomas ; FRCPath² ; Jessica Glen ; MSc³ ; Smita Padhi ; MBBS ; MPH³ ; Ben A.J. Pordes ; BSc³ ; David Wonderling ; MSc³ ; Roy Connell ; RN (Child) ; MSc⁴ ; Suzanne Stephens ; MBBS ; FRCPCH⁵ ; Ashraf I. Mikhail ; MD ; FRCP⁶ ; Damian G. Fogarty ; MD⁷ ; Jan K. Cooper⁸ ; Belinda Dring ; BSc ; MPH⁴ ; Mark A.J. Devonald ; FRCPE⁴ ; Chris Brown ; MPharm⁶ ; Mark E. Thomas ; FRCP⁹ ; ^{mark.thomas@heartofengland.nhs.uk" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Anemia ; iron deficiency ; chronic kidney disease (CKD) ; hemodialysis ; iron therapy ; intravenous iron ; diagnostic tests ; erythropoietin ; inflammation ; hypersensitivity ; iron overload ; National Institute for Health and Care Excellence (NICE) ; clinical practice guideline
• 刊名：American Journal of Kidney Diseases
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：67
• 期：4
• 页码：548-558
• 全文大小：649 K

文摘

The UK-based National Institute for Health and Care Excellence (NICE) has updated its guidance on iron deficiency and anemia management in chronic kidney disease. This report outlines the recommendations regarding iron deficiency and their rationale. Serum ferritin alone or transferrin saturation alone are no longer recommended as diagnostic tests to assess iron deficiency. Red blood cell markers (percentage hypochromic red blood cells, reticulocyte hemoglobin content, or reticulocyte hemoglobin equivalent) are better than ferritin level alone at predicting responsiveness to intravenous iron. When red blood cell markers are not available, a combination of transferrin saturation < 20% and ferritin level < 100 ng/mL is an alternative. In comparisons of the cost-effectiveness of different iron status testing and treatment strategies, using percentage hypochromic red blood cells > 6% was the most cost-effective strategy for both hemodialysis and nonhemodialysis patients. A trial of oral iron replacement is recommended in people not receiving an erythropoiesis-stimulating agent (ESA) and not on hemodialysis therapy. For children receiving ESAs, but not treated by hemodialysis, oral iron should be considered. In adults and children receiving ESAs and/or on hemodialysis therapy, intravenous iron should be offered. When giving intravenous iron, high-dose low-frequency administration is recommended. For all children and for adults receiving in-center hemodialysis, low-dose high-frequency administration may be more appropriate.