Intravenöse Eisengabe bei CKD-Patienten - Kann sie neben der Anämie auch kardiovaskuläre Endpunkte beeinflussen?

Herzinsuffizienz (HI) ist die häufigste kardiovaskuläre Diagnose bei Patienten mit chronischer Niereninsuffizienz (CNI) im Endstadium. Ein gemeinsames Begleitsymptom dieser doppelt belasteten und äußerst vulnerablen Patientengruppe ist die Anämie. Aufgrund neuerer Studiendaten mit Eisencarboxymaltose wird intravenöses (i. v.) Eisen auch als Therapieoption bei HI intensiv diskutiert. Damit stellt sich die Frage, ob eine Gabe von i. v. Eisen bei CNI-Patienten mit HI zu erwägen wäre, auch wenn diese unter dem Blickwinkel der reinen Anämiekontrolle eigentlich nicht behandlungsbedürftig sind. Im Hinblick auf die aktuelle Studienevidenz ist es vorerst zu früh, i. v. Eisen bei CNI-Patienten auch zur Therapie einer HI einzusetzen. Aktuell sollte i. v. Eisen auch bei CNI-Patienten mit HI zur Anämietherapie appliziert und die Empfehlungen hinsichtlich der maximalen Serum-Ferritin-Spiegel beachtet werden. Aufgrund der heterogenen Empfehlungen zur Obergrenze ist jedoch eine individuelle Nutzen-Risiko-Analyse für jeden Patienten notwendig.

Intravenous iron is a common treatment option for chronic kidney disease (CKD) patients with anemia. Among end-stage CKD patients, the most common cardiovascular comorbidity is chronic heart failure (CHF). Recent studies suggest a possible benefit of intravenous iron (ferric carboxymaltose) also for patients with CHF irrespective of anemia. Thus, this article discusses the question, whether intravenous iron might also be an option for treatment of CKD/HI patients beyond the scope of anemia treatment. Although it is currently not possible to recommend intravenous iron for HI treatment, it is a valid option for treatment of anemia in CKD/HI patients. Most importantly, maximum serum ferritin levels should be taken into account for therapy according to the latest international guidelines. But due to the very heterogeneous recommendations about this maximum, an individual risk-benefit-evaluation for every patient is mandatory.

Key words

chronic kidney disease - chronic heart failure - anemia - intravenous iron - ferric carboxymaltose

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