Nghiên cứu biến đổi tình trạng sắt ở bệnh nhân suy thận mạn giai đoạn cuối điều trị Erythropoietin

Background: Iron deficiency is common in anemia patients with end-stage renal disease (ESRD) undergoing hemodialysis and is the main cause leading to decreased erythropoietin (EPO) therapeutic response. Combined intravenous iron therapy may provide optimal results in the treatment of anemia but can also cause iron overload. The authors conducted this study to assess changes ferritin level, transfenin saturation (Tsat) in patients with ESRD undergoing hemodialysis, EPO and intravenous iron treatments. Subjects and Methods: Patients were followed up for the first 3 months of hemodialysis treatment with 3 sessions per week, bicarbonate dialysis solution; EPO dose from 4000UI to 6000UI per week, intravenous iron (Iron sucrose) dose from 0 mg to 200 mg per month. Results: The average age of patients was 44.7. Mean-dose of intravenous iron was 176.3 mg per month. After treatment, the mean fenitin level was 564.49 + or - 416.58 ng/ml which didn't increase significantly compared with previous treatment (538.73 + or - 423.07 ng/ml) (p 0.05). Transfenin saturation (Tsat) after treatment was 27.05 + or - 13.94 percent which was significantly higher compared with previous treatment (23.41 + or - 10.23 percent) with p 0.01. Percentage of patients at risk for iron overload (ferritin level or = 500ng/ml, Tsat or = 50 percent) wasn't higher significantly compared with previous treatment (p 0.05). The rate of low iron stores after treatment was 14.5 percent which didn't reduce significantly compared with previous treatment (22.1 percent) with p 0.05 but low Tsat rate was 26 percent which reduced very significantly compared with previous treatment (45.8 percent) with p 0.001. In group treated 200mg intravenous iron per month, the ferritin level increased very significantly after treatment compared to before treatment (p 0.001) and Tsat was also increased significantly with p 0.01. In group with 100mg iron dose, there were no significant differences in both ferritin level and Tsat (p 0.05). Conclusion: With intravenous iron dose of 176.3 mg per month, fenitin level didn't increase significantly but Tsat increased significantly (p 0.001) and there wasn't a significant increase the proportion of patients with iron overload risk. With 200mg iron dose per month, there was a significant increases the ferritin level and Tsat with p 0.001 and p 0.01, respectively.