CKD铁剂管理来自KDIGO相关争议问题会议的结论.PDF

CKD 铁剂管理： 来自KDIGO 相关争议问题会议的结论 原文：Iron management in chronic kidney disease: conclusions from a “Kidney Disease: Improving Global Outcomes” (KDIGO) Controversies Conference. doi: 10.1016/j.kint.2015.10.002. 原文作者：Iain C. Macdougall, Andreas J. Bircher, Kai-Uwe Eckardt, Gregorio T. Obrador, Carol A. Pollock, Peter Stenvinkel, Dorine W. Swinkels, Christoph Wanner, Gu¨nter Weiss, and Glenn M. Chertow; for Conference Participants 龚德华，陈佩玲 翻译，张 炯，侯金花 整理 南京总医院 国家肾脏疾病临床医学研究中心 摘要 在 1989 年红细胞生成刺激因子（ESAs）问世以前，终末期肾病患者常需反复输血而致 铁超载，因此补铁的需求较少。但随着ESAs 的广泛应用，为增加血红蛋白的反应性及为经 济、安全原因减少 ESAs 剂量的目的，人们认识到铁剂的应用是必需的。同时发现静脉补铁 较口服效果更佳，因此近些年静脉铁剂的使用越来越多。由于铁剂的使用可能会带来铁超载， 氧化应激，超敏反应及增加感染的风险等不利影响，其使用的安全性也逐渐受到关注。因此， KDIGO 组建专家组进行此次会议以评估铁剂使用的利与弊，并提出合理使用方案以减轻其急 性不良反应及其它副作用。 关键词 慢性肾脏病，超敏反应，感染，铁剂超载，氧化应激 Iron management in chronic kidney disease: conclusions from a “Kidney Disease: Improving Global Outcomes” (KDIGO) Controversies Conference Iain C. Macdougall, Andreas J. Bircher, Kai-Uwe Eckardt, Gregorio T. Obrador, Carol A. Pollock, Peter Stenvinkel, Dorine W. Swinkels, Christoph Wanner, Gu¨ nter Weiss, and Glenn M. Chertow; for Conference Participants ABSTRACT Before the introduction of erythropoiesis-stimulating agents (ESAs) in 1989, repeated transfusions given to patients with end-stage renal disease caused iron overload, and the need for supplemental iron was rare. However, with the widespread introduction of ESAs, it was recognized that supplemental iron was necessary to optimize hemoglobin response and allow reduction of the ESA dose for economic reasons and recent concerns about ESA safety. Iron supplementation was also found to be more efficacious via intravenous compared to oral administration, and the use of intravenous iron has escalated in recent years. The safety of various