RESUMO
BACKGROUND: Provision of adequate iron to support erythropoiesis in patients with chronic kidney disease (CKD) is time consuming and may present adherence problems for patients in the outpatient setting. We studied an accelerated regimen of high-dose intravenous iron sucrose therapy in a cohort of iron-deficient, anemic CKD patients. METHODS: Intravenous iron sucrose 500 mg was infused over three hours on two consecutive days in 107 CKD patients (glomerular filtration rate, 32.3 +/- 19.6 mL/min/1.73m2, baseline hemoglobin 10.2 +/- 1.7 g/dL). Iron indices (transferrin saturation, ferritin) were measured at baseline and at two and seven days after completion of the iron regimen. Blood pressures were monitored immediately prior to, and hourly throughout the iron sucrose infusions. RESULTS: Transferrin saturation and serum ferritin increased from 18.5 +/- 8.5% and 177 +/- 123.8 ng/mL at baseline to 40.2 +/- 22.3% and 811 +/- 294.1 ng/mL in 102 evaluated patients (P < 0.015). In 55 patients with additional measurements at 7 days post-dosing, the transferrin saturation and ferritin had fallen to 26.3 +/- 10.6% and 691 +/- 261.8 ng/mL (P < 0.015 compared to two days' post-dose). Blood pressure rose slightly, but not significantly, throughout the infusions, and altering the infusion rate was not necessary. Two patients had seven adverse events that were considered related to iron sucrose. CONCLUSION: An accelerated regimen of high-dose intravenous iron sucrose therapy in CKD patients is safe and effective in restoring iron stores, and may potentially save time and improve patient adherence.
Assuntos
Anemia/tratamento farmacológico , Compostos Férricos/administração & dosagem , Compostos Férricos/efeitos adversos , Falência Renal Crônica/complicações , Idoso , Anemia/etiologia , Pressão Sanguínea/efeitos dos fármacos , Feminino , Óxido de Ferro Sacarado , Ferritinas/sangue , Ácido Glucárico , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Transferrina/metabolismo , Resultado do TratamentoAssuntos
Hiperpotassemia/induzido quimicamente , Antagonistas de Receptores de Mineralocorticoides/efeitos adversos , Infarto do Miocárdio/tratamento farmacológico , Espironolactona/análogos & derivados , Espironolactona/efeitos adversos , Contraindicações , Creatinina/metabolismo , Eplerenona , Humanos , Infarto do Miocárdio/complicações , Espironolactona/uso terapêutico , Disfunção Ventricular Esquerda/tratamento farmacológico , Disfunção Ventricular Esquerda/etiologiaAssuntos
Antagonistas de Receptores de Angiotensina , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Diuréticos/uso terapêutico , Taxa de Filtração Glomerular/efeitos dos fármacos , Taxa de Filtração Glomerular/fisiologia , Hiperpotassemia/prevenção & controle , Hiperpotassemia/fisiopatologia , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Receptores de Angiotensina/uso terapêutico , Espironolactona/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Creatinina/sangue , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Hiperpotassemia/induzido quimicamente , Masculino , Falha de TratamentoRESUMO
The differential diagnosis for patients with acute renal failure of their native kidneys, as a result of primary intrarenal disease, includes acute tubular necrosis, glomerulonephritis, and interstitial nephritis. The role of MAG3 renography has not been studied in this setting. The authors describe four patients with acute renal failure in whom MAG3 renal imaging reliably identified acute tubular necrosis, as confirmed by follow-up kidney biopsies. In contrast to the poor parenchymal uptake observed in glomerulonephritis and interstitial nephritis, MAG3 shows a distinctive pattern in patients with acute tubular necrosis. For patients with acute renal failure, a renal scan can facilitate decision-making regarding the initiation of therapy.