Dialysate iron therapy: Infusion of soluble ferric pyrophosphate via the dialysate during hemodialysis

被引:45
作者
Gupta, A
Amin, NB
Besarab, A
Vogel, SE
Divine, GW
Yee, J
Anandan, JV
机构
[1] Henry Ford Hosp, Div Nephrol, Detroit, MI 48202 USA
[2] Henry Ford Hosp, Dept Pharm Serv, Detroit, MI 48202 USA
[3] Henry Ford Hosp, Dept Biostat, Detroit, MI 48202 USA
关键词
dialysis; iron supplementation; renal toxicity; colloidal iron dextran; erythropoietin; anemia;
D O I
10.1046/j.1523-1755.1999.00436.x
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:1891 / 1898
页数:8
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