慢性肾脏病患者铁剂应用的新思考PPT课件.ppt

*静脉铁剂是一把双刃剑，它能有效纠正体内铁缺乏，提高EPO疗效，减少EPO用量，但是它又能引起严重不良反应，临床医师必须对此熟知。2006年K/DOQI指南更作了如此强调：每次右旋糖酐铁静脉给药，都要备好急救复苏药品，并有经过培训能识别及处理严重过敏反应（包括复苏）的医务人员在场。**目前存在异议来源于2014年肾性贫血诊断与治疗中国专家共识**既往认为，口服补铁不及静脉补铁。近来有观点，对此表示疑义现在有观点认为口服和静脉补铁相比，无论是血色素纠正情况、体内铁储备的情况，肾脏GFR下降的速度均无明显差异但是感染及心血管事件的发生率存在显著差异*AgarwalR.KidneyInt.2015，88(4):905Hemoglobinchangefrombaselineto3monthsintheoralirongroupwas0.61g/dLandintheIVirongroup0.69g/dL(difference+0.08(95%CI?0.34to+0.51,p=0.72).Differenceat6months(0.22g/dL,p=0.3),12months(?0.04g/dL,p=0.85)and24months(0.15g/dL,p=0.56)werealsonotstatisticallysignificant*Transferrinsaturationchangefrombaselineto3monthsintheoralirongroupwas0.03andintheIVirongroup0.05(p=0.10).Differenceat6months(p=0.85)and24months(p=0.14)werealsonotstatisticallysignificant.Logtotalironbindingcapacitychangefrombaselineto3monthsintheoralirongroupwas?0.031(p=0.13)andintheIVirongroup?0.098(p0.001).Differencesinchangefrombaselineat6months(?0.030,p=0.31),12months(p=0.015)and24months(,p=0.74)weresmall.Logerritinchangefrombaselineto3monthsintheoralirongroupwas?0.20(p=0.01)andintheIVirongroup0.84(p0.001)Differencesbetweengroupsinchangefrombaselineat6months(0.39,p=0.001),12months(p=0.085)and24months(0.04,p=0.77)diminished.*ThisFigureisamodelfurtheradjustedforage,sex,race,ACEorARBuse,andcardiovasculardisease.Thiswasthesecondaryendpoint:slopefororaliron?3.8mL/min/1.73m2peryear,IViron?3.9mL/min/1.73m2peryear,betweengroupdifferenceby0.11mL/min/1.73m2peryear(95%confidenceinterval(CI)?2.7to2.5,p=0.94).*静脉补铁组：感染发生率36.6/100病人年，显著高于口服补铁组（25.8/100病人年）。感染部位包括肺、骨、皮肤、泌尿道等（p=0.006）左心衰、心绞痛、急性心肌梗塞等心血管事件的发生率，CVD发生率达54.4/100病人年，显著高于口服补铁组的54.4/100病人年（p0.001）*与口服补铁组相比，静脉补铁组因各种原因住院的发生率增加2倍*Forthisreason,itisofimporta