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Evaluation and treatment of iron deficiency in renal anemia

2017-03-03 11:04

 

 

Chronic kidney disease (CKD) 4,5 patients are often associated with renal anemia, the need for the application of erythropoietin (EPO) treatment, and EPO an important basis for the onset of the patient must have sufficient iron - it is red blood cells An important part of hemoglobin.

Healthy adult body iron content of 3 to 4.5 grams. The body of iron mainly from the aging and destruction of red blood cells, can provide re-use of iron 21mg a day, and daily intake of iron from food only about 1mg. Coffee, tea, spinach, plant cellulose are not conducive to the absorption of iron.

Long-term dialysis patients in what circumstances need to use iron, how to apply in order to get a better effect?

Serum ferritin (SF) and transferrin saturation (TSAT) are the most commonly used and simple indicators for assessing iron deficiency in patients and should be tested regularly (every 1 to 3 months).

SF <100 ng / ml or combined TSAT <20%, is absolutely iron deficiency

SF normal or high, TSAT <20% for the functional iron deficiency (relative to iron deficiency)

In the diagnosis of iron deficiency in patients need to give iron treatment. Iron can choose oral iron, easy to take and patients with better compliance, but the low bioavailability of oral iron, gastrointestinal side effects of high incidence, it is difficult to achieve the desired effect. The American Kidney Disease Foundation dialysis guide (K / DOQI) suggests that intravenous iron therapy meets the requirements of treatment.

The best iron target value SF: 200 ~ 500ng / ml, TSAT: 30 ~ 50%

CKD patients with target hemoglobin should be maintained at> 11.0g / dl

Intravenous iron with the program
 

1. Absolute iron deficiency in adult hemodialysis patients intravenous iron, each dialysis intravenous injection of 100mg, a total of 10 times;
 

2. Maintenance of iron therapy and functional iron deficiency treatment and prevention, weekly intravenous iron tablets 25 ~ 100mg, a total of 10 weeks.

TSAT and SF should be monitored during the application of iron. When TSAT> 50%, SF> 800ng / ml, disable intravenous iron for 3 months and review TSAT and SF.

In short, the need for a correct evaluation of CKD patients with iron deficiency, monitoring TSAT, SF, timely adjustment of iron treatment program, the ultimate goal is to correct the patient's anemia, improve quality of life.

 

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