Eisen bei der Behandlung der renalen Anämie

ZUSAMMENFASSUNG

Dextranfreies parenterales Eisen (Fe) ist sicher und wirksam. Es erhöht auch ohne Erythropoese stimulierende Agenzien (ESA) das Bluthämoglobin (Hb) und verbessert die Lebensqualität. Parenterales Fe reduziert Hospitalisierungen wegen Herzinsuffizienz bei Patienten mit linksventrikulärer Ejektionsfraktion (LVEF) von < 50 % und normalem Hb sowie bei Hämodialysepatienten. Bei Patienten mit eingeschränkter Nierenfunktion (CKD) und/oder Herzfunktion sind die Laborparameter für den Fe-Haushalt nur wenig valide und der Ausschluss eines Eisenmangels ist oft nur durch eine probatorische Fe-Gabe zu leisten. Fe-Mangel führt zu Thrombophilie. Unter ESA-Therapie wird Fe verbraucht. Orale Fe-Präparate haben eine geringe Bioverfügbarkeit, die bei CKD-Patienten weiter sinkt. Stabilisatoren des Hypoxie induzierbaren Faktors (HIF) transaktivieren eine Reihe von Genen, die die Fe-Resorption und -Verwertung verbessern. Große, randomisiert-kontrollierte Studien (RCTs) mit HIF-Stabilisatoren an CKD-Patienten unter überwiegend oralem Fe erbrachten jedoch keinen Vorteil in Bezug auf harte Endpunkte.

Publication History

Article published online:
21 March 2024

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