ABSTRACT
Anemia is a frequent complication of CKD and has numerous physiologic effects. In the treatment of anemia it is important to guarantee adequate iron storesfor hemoglobin synthesis. The aim of this study is to report on the impact of iron reposition on hemoglobin levels in patients with CKD stages 3 to 5. Fortyanemic patients (hemoglobin <11.0 g/dL) with CKD stages 3 (17,5%), 4 (58,5%), and 5 (25%), not receiving re-Hu-Erithropoetin were treated with IV iron(Noripurum, Altana Pharma), a ferric sucrose product. Iron deficiency was diagnosed when transferrin saturation was <20% and/or ferritin <100 mg/L. TheIV Iron (100 mg/ ampoules) was given in 150 mL of saline over 90 minutes. Glomerular filtration rate (GFR) was estimated from serum creatinine using theMDRD formula, and patients were categorized according to the stages defined by K/DOQI of the NKF. The mean age of the patients was 58.6±17 yearsand 56% were female. The main causes of CKD were hypertension (33.0%), diabetes mellitus (19.0%) and glomerulonephritis (19.0%). The mean valuesof the lab results before and after the IV iron administration were: creatinine (2.79±1.28 and 3.01±1.84, p>0.90), GFR (25.92±13.4 and 26.14±13.34, p>0.29), serum iron (58.3±28 and 90.9, p>0.60), transferrin saturation index (22.94±11.36 and 27.4±8, p>0.49), ferritin (84.69±78.3 and 164.8±141, p<0.04) andhemoglobin (9.52±1.24 and 10.53±1.44, p<0.000). The mean amount of IV iron sucrose administered was 319±180mg. The IV iron was very well toleratedand no serious side effect was observed. In conclusion, administration of IV Noripurum, a dextran-free iron compound, was safe and showed a beneficial impact on the hemoglobin level, and its use optimized the treatment of anemia in patients with CKD.
A anemia é uma complicação freqüente na doença renal crônica (DRC) e determina vários efeitos fisiológicos. No tratamento da anemia, é importantegarantir a reserva de ferro adequada para a síntese de hemoglobina. O objetivo deste trabalho é relatar sobre o impacto da reposição de ferro nos níveisde hemoglobina em pacientes com anemia decorrente da DRC na fase pré-dialítica. Quarenta pacientes anêmicos (hemoglobina <11,0g/dL) com DRCestágios 3 (17,5%), 4 (58,5%) e 5 (25%), não tratados com eritropoetinina humana recombinante, receberam ferro venoso (sacarato de hidróxido de ferroIII, Noripurum, ALTANA Pharma). A deficiência de ferro foi diagnosticada quando o índice de saturação da transferrina (%) foi inferior <20%, associado ounão à ferritina (mg/dL) <100mg/dL. O ferro endovenoso foi administrado na dose de 100mg diluído em 150mL de soro fisiológico no período de 90 minutos.A filtração glomerular (mL/min/1,73m2) foi estimada a partir da creatinina sérica (mg/dL) através da fórmula do estudo MDRD e os pacientes foramestagiados segundo as diretrizes brasileiras sobre DRC e o K/DOQI da National Kidney Foundation. A idade média dos pacientes foi de 58,6 ±17 anos,sendo 56% do sexo feminino. As principais causas de DRC foram hipertensão arterial (33,0%), diabetes mellitus (19,0%) e glomerulonefrites (19,0%). Osvalores médios dos resultados laboratoriais antes da reposição de ferro e após foram: creatinina (2,79±1,28mg/dL e 3,02±1,84mg/dL, p= 0,90), FG(25,92±13,4mL/min/1,73m2 e 26,14±13,34mLmin/1,73m2, p= 0,29), ferro sérico (58,3±28 e 90,9±35, p= 0,60), índice de saturação da transferrina(22,94±11,36% e 27,40±8,0, p= 0,49), ferritina (84,69±78,3 e 164,8±13,34, p<0,004) e hemoglobina (9,52±1,24g/dL e 10,53±1,44, p<0000). A quantidademédia de sacarato de hidróxido de ferro III administrada foi de 319±178mg.