原文

Introduction

Iron therapy in patients with CKD: the evidence base for the 2012 KDIGO guideline

• TSAT ≤30% and ferritin ≤500 µg/L
• CKD-5D: 不建議口服
• Guideline的各種建議, evidence level都很低

New evidence: the FIND-CKD and REVOKE trials

• Shepshelovich et al. meta-analysis: 用IV比用PO更易升Hb (CKD-ND及CKD-5D皆是)
• FIND-CKD
  • CKD-ND
  • 三個arms
    • IV ferric carboxymaltose 1000 mg q4w, 目標ferritin 400-600
    • IV ferric carboxymaltose 200 mg q4w, 目標ferritin 100-200
    • PO iron 200 mg/day
  • High-dose IV比PO有效
• REVOKE
  • CKD-ND (3/4)
  • PO ferrous sulfate (65 mg elemental iron), for 8 weeks
  • IV iron sucrose 200 mg q2w for total 1 gm
  • 效果相同, 但IV有較高的AEs, 研究提早中止

New evidence: observational studies

• DOPPS 2002-2011: IV 300-399 mg/month死亡率最高, 對照為100-199 mg/month
• DEcIDE-ESRD study: < 1050 mg/3 month or < 2100 mg/6 month, 死亡率沒差
• Brookhart et al. : bolus (≥100 mg, 至少連2次, 總劑量在30天內至少600 mg)打法的risk稍高, 主要是感染症, 特別是有catheter者
• 整體結論: 無定論

Future prospects: the Proactive IV Iron Therapy in Dialysis Patients (PIVOTAL) trial