Download PDF
Dialyse aktuell 2013; 17(S 01): S11-S16
DOI: 10.1055/s-0034-1368102
Nephrologie
© Georg Thieme Verlag Stuttgart · New York

Eisenpräparate in der Nephrologie – Produkte, Applikationsformen und Wirkungsmechanismen

Iron preparations in nephrology – Products, application types and mechanisms of action
Jan Galle
1   Klinik für Nephrologie und Dialyseverfahren, Klinikum Lüdenscheid (Direktor: Prof. Dr. Jan Galle)
› Author Affiliations
Further Information

Publication History

Publication Date:
20 January 2014 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Ein wichtiger Kofaktor für die Anämie chronisch Nierenkranker ist der Eisenmangel. In der Behandlung der renalen Anämie ist die Berücksichtigung ausreichender Eisenspeicher in den letzten Jahren deutlich in den Vordergrund gerückt. Die kürzlich veröffentlichten Leitlinien der internationalen KDIGO-Initiative haben die Zielwerte für relevante Messparameter des Eisenstoffwechsels wie Transferrinsättigung und Ferritin nach oben verschoben, während die Zielwerte für den Serum-Hämoglobin-Wert nach unten korrigiert wurden. Diese Veränderungen beziehen sich sowohl auf Prädialyse- wie auf Dialysepatienten. Zur Eisensubstitution stehen orale wie intravenös zu verabreichende Substanzen zur Verfügung. Da die enterale Eisenresorptionskapazität niedrig ist, wird eine orale Substitution meist nur zum Erhalt ausreichender Eisenspeicher im Prädialysebereich reichen können, nicht aber zum Auffüllen entleerter Speicher. Hierzu wird in der Regel eine intravenöse Eisengabe notwendig sein. Die verschiedenen zur Verfügung stehenden Eisenpräparate unterscheiden sich in ihrer Zusammensetzung, Verträglichkeit und in der maximal pro Einzelverabreichung möglichen Höchstdosis. Ein orientierender Vergleich soll hier dargestellt werden.

Summary

Iron deficiency is an important cofactor for anemia in patients with chronic kidney disease. Repletion of insufficient iron stores has become a major issue in the treatment of renal anemia. In the recently published anemia guidelines of the international KDIGO initiative, the targets for relevant parameters of iron metabolism such as transferrin saturation and serum ferritin have been increased, while at the same time the targets for serum hemoglobin were lowered. These changes refer to pre-dialysis as well as to dialysis patients. Oral as well as intravenous preparations are available for iron repletion. In view of the low capacity of enteral iron resorption, oral substitution is sufficient only in the pre-dialysis setting or for maintenance of sufficient iron stores. However, for repletion of emptied iron stores, intravenous iron therapy will be necessary. The commercially available iron preparations differ in composition, side effects and maximal dose of a single application and shall be compared in this short overview.

Key words

iron - preparations - nephrology - products - application types - mechanisms of action
 

  • Literatur

  • 1 Andrews NC. Anemia of inflammation: the cytokine-hepcidin link. J Clin.Invest 2004; 113: 1251-1253
    Google Scholar
  • 2 Cavill I. Erythropoiesis and iron. Best Pract Res Clin Haematol 2002; 15: 399-409
    Google Scholar
  • 3 Eschbach JW. Iron requirements in erythropoietin therapy. Best Pract Res Clin Haematol 2005; 18: 347-361
    CrossrefGoogle Scholar
  • 4 Drüeke TB, Parfrey PS. Summary of the KDIGO guideline on anemia and comment: reading between the (guide)line(s). Kidney Int 2012; 82: 952-960
    CrossrefGoogle Scholar
  • 5 Ganzoni AM. [New aspects of iron deficiency]. Schweiz Med Wochenschr 1970; 100: 691-697
    Google Scholar
  • 6 Balakrishnan VS, Rao M, Kausz AT et al. Physicochemical properties of ferumoxytol, a new intravenous iron preparation. Eur J Clin Invest 2009; 39: 489-496
    CrossrefGoogle Scholar
  • 7 Schwenk MH. Ferumoxytol: a new intravenous iron preparation for the treatment of iron deficiency anemia in patients with chronic kidney disease. Pharmacotherapy 2010; 30: 70-79
    CrossrefGoogle Scholar
  • 8 Lyseng-Williamson KA, Keating GM. Ferric carboxymaltose: a review of its use in iron-deficiency anaemia. Drugs 2009; 69: 739-756
    CrossrefGoogle Scholar
  • 9 Qunibi WY, Martinez C, Smith M et al. A randomized controlled trial comparing intravenous ferric carboxymaltose with oral iron for treatment of iron deficiency anaemia of non-dialysis-dependent chronic kidney disease patients. Nephrol Dial Transplant 2011; 26: 1599-1607
    CrossrefGoogle Scholar
  • 10 Charytan C, Bernardo MV, Koch TA et al. Intravenous ferric carboxymaltose versus standard medical care in the treatment of iron deficiency anemia in patients with chronic kidney disease: a randomized, active-controlled, multi-center study. Nephrol Dial Transplant 2013; 28: 953-964
    CrossrefGoogle Scholar
  • 11 Macdougall IC, Geisser P. Use of intravenous iron supplementation in chronic kidney disease: an update. Iran J Kidney Dis 2013; 7: 9-22
    Google Scholar
  • 12 Wikstrom B, Bhandari S, Barany P et al. Iron isomaltoside 1000: a new intravenous iron for treating iron deficiency in chronic kidney disease. J Nephrol 2011; 24: 589-596
    CrossrefGoogle Scholar
  • 13 Swaminathan S, High WA, Ranville J et al. Cardiac and vascular metal deposition with high mortality in nephrogenic systemic fibrosis. Kidney Int 2008; 73: 1413-1418
    CrossrefGoogle Scholar
  • 14 Swaminathan S, Horn TD, Pellowski D et al. Nephrogenic systemic fibrosis, gadolinium, and iron mobilization.. N Engl J Med 2007; 357: 720-722
    CrossrefGoogle Scholar
  • 15 Chapoutot C, Esslimani M, Joomaye Z et al. Liver iron excess in patients with hepatocellular carcinoma developed on viral C cirrhosis. Gut 2000; 46: 711-714
    CrossrefGoogle Scholar
  • 16 Locatelli F, Barany P, Covic A et al. Kidney Disease: Improving Global Outcomes guidelines on anaemia management in chronic kidney disease: a European Renal Best Practice position statement. Nephrol Dial Transplant 2013; 28: 1346-1359
    CrossrefPubMedGoogle Scholar
  • 17 Pisoni RL, Fuller DS, Bieber BA, Gillespie BW, Robinson BM. The DOPPS Practice Monitor for US dialysis care: trends through August 2011. Am J Kidney Dis 2012; 60: 160-165
    CrossrefGoogle Scholar