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Nephrologie aktuell 2024; 28(02): 62-73
DOI: 10.1055/a-2193-2993
Schwerpunkt
Nephrologie

Eisen bei der Behandlung der renalen Anämie

Grundlagen und aktuelle Aspekte
Christian Rosenberger
1   Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivtherapie, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, Berlin
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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.



Publikationsverlauf

Artikel online veröffentlicht:
21. März 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
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