维持性血液透析患者静脉补铁:对PIVOTAL研究结论的再思考  

Intravenous iron in patients undergoing maintenance hemodialysis: rethinking of the conclusion of PIVOTAL study

作　　者：邢婕(综述) 张晓良(审校)[1] XING Jie;ZHANG Xiaoliang(Department of Nephrology,Zhongda Hospital,School of Medicine,Southeast University,Nanjing 210009,China)

机构地区：[1]东南大学附属中大医院肾内科,南京210009

出　　处：《肾脏病与透析肾移植杂志》2022年第3期277-280,共4页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家自然科学基金(81570612、81870497);江苏省重点研发计划-社会发展(BE2021737);南京市卫生科技发展专项(YKK20237,YKK21268)。

摘　　要：2019年《新英格兰医学杂志》刊登了PIVOTAL(Proactive IV Iron Therapy in Haemodialysis Patients)研究的结果“Intravenous Iron in Patients Undergoing Maintenance Hemodialysis”,该RCT研究显示了大剂量静脉铁剂在维持性血液透析患者中应用的有效性和安全性,引起广泛关注。作者结合既往及最近的多项临床研究及相关指南的数据,深入学习和思考,提出几点关键问题与专家、同道商榷和探讨。作者认为大剂量静脉铁剂在维持性血液透析患者中的有效性及安全性仍存在诸多争议,需要更多高质量的研究证据来证实。目前临床应予患者个体化补铁治疗,加强脏器铁载量的监测以避免铁过载,大剂量使用静脉铁剂时需谨慎。In 2019, the New England Journal of Medicine published the results of the PIVOTAL(Proactive IV Iron Therapy in Haemodialysis Patients) study “Intravenous Iron in Patients Undergoing Maintenance Hemodialysis”, which showed the efficacy and safety of high-dose intravenous iron in maintenance hemodialysis patients and attracted much attention. However, the authors put forward several key issues to discuss with experts and colleagues in combination with the in-depth study, thinking of a number of previous and recent clinical studies and related guidelines. The authors concluded that there are still many controversies about the efficacy and safety of high-dose intravenous iron in maintenance hemodialysis patients, which need to be confirmed by more researches with high grade evidence. At present, individualized iron supplementation should be used in clinical application, in the meantime, the monitoring of organ iron overload should be strengthened to avoid iron overload. High-dose intravenous iron should still be used with extreme caution in clinical practice.

关 键 词：维持性血液透析 静脉铁剂 大剂量 铁过载 

分 类 号：R47[医药卫生—护理学]