Dialysate iron therapy: Infusion of soluble ferric pyrophosphate via the dialysate during hemodialysis
Dialysate iron therapy: Infusion of soluble ferric pyrophosphate via the dialysate during hemodialysis
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DOI：
10.1046/j.1523-1755.1999.00436.x
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发表时间：
1999-05-01
影响因子：
19.6
通讯作者：
Anandan, JV
中科院分区：
文献类型：
--
作者：
Gupta, A;Amin, NB;Anandan, JV
背景可溶性铁盐对于肠胃外给药是有毒的，因为游离铁催化自由基的产生。焦磷酸盐强烈地络合铁并增强铁在转铁蛋白、铁蛋白和组织之间的转运。血液透析患者需要铁来补充持续的损失。我们评估了通过透析液输注可溶性焦磷酸铁的短期安全性和有效性。接受促红细胞生成素的维持性血液透析患者在常规剂量的静脉内（i. v.）口服铁补充剂后停止右旋糖酐铁。在治疗阶段，10例患者通过血液透析接受焦磷酸铁，透析液铁浓度从2、4、8逐渐增加到12 μ g/dl，然后在12 μ g/dl的水平持续两个月（透析液铁组）; 11例对照患者继续静脉注射右旋糖酐铁（静脉注射铁组）。血红蛋白、血清铁参数和促红细胞生成素剂量从第0个月到第6个月没有显著变化，两组内和两组之间都是如此。在第6个月期间维持铁平衡所需的静脉注射铁的每周剂量（平均值+/- so）在静脉注射铁组中为56 +/- 37 mg，而透析液铁组为10 +/- 23 mg（P = 0.001）。静脉铁剂组的所有11名患者都需要静脉铁剂，而接受12 μ g/dl透析液铁剂的10名患者中只有2名需要静脉铁剂。两组不良反应的发生率相似。结论。通过血液透析缓慢输注可溶性焦磷酸铁可能是维持性血液透析患者静脉注射胶体右旋糖酐铁的安全有效的替代方法。
Background. Soluble iron salts are toxic for parenteral administration because free iron catalyzes free radical generation. Pyrophosphate strongly complexes iron and enhances iron transport between transferrin, ferritin, and tissues. Hemodialysis patients need iron to replenish ongoing losses. We evaluated the short-term safety and efficacy of infusing soluble ferric pyrophosphate by dialysate.Methods. Maintenance hemodialysis patients receiving erythropoietin were stabilized on regular doses of intravenous (i.v.) iron dextran after oral iron supplements were discontinued. During the treatment phase, 10 patients received ferric pyrophosphate via hemodialysis as monthly dialysate iron concentrations were progressively increased from 2, 4, 8, to 12 mu g/dl and were then sustained for two additional months at 12 mu g/dl (dialysate iron group); 11 control patients were continued on i.v. iron dextran (i.v. iron group).Results. Hemoglobin, serum iron parameters, and the erythropoietin dose did not change significantly from month 0 to month 6, both within and between the two groups. The weekly dose of i.v. iron (mean +/- so) needed to maintain iron balance during month 6 was 56 +/- 37 mg in the i.v, iron group compared with 10 +/- 23 mg in the dialysate iron group (P = 0.001). Intravenous iron was required by all 11 patients in the i.v. iron group compared with only 2 of the 10 patients receiving 12 mu g/dl dialysate iron. The incidence of adverse effects was similar in both groups.Conclusions. Slow infusion of soluble iron pyrophosphate by hemodialysis may be a safe and effective alternative to the i.v. administration of colloidal iron dextran in maintenance hemodialysis patients.