现代静脉注射铁对纤维细胞生长因子23和非透析依赖性CKD中的酸盐的差异作用 - 探索性随机控制双盲研究ExplorIRON-CKD
Xenophon Kassianides1, Sunil Bhandari2
1Academic Renal Research Department, Hull University Teaching Hospitals NHS Trust and the Hull York Medical School, Kingston upon Hull, UK. x.kassianides@nhs.net.
BMC nephrology
|February 12, 2024
概括
铁脱脂糖 (FDI) 和铁糖糖 (FCM) 在非透析依赖的慢性病 (CKD) 患者中具有相似的疗效. 然而,FCM显著增加了纤维细胞生长因子23 (FGF23),可能会影响骨循环和维生素D水平.
科学领域:
- 脏病学和内分泌学
- 慢性脏疾病中的矿物质和骨代谢.
背景情况:
- 静脉注射铁是治疗非透析性慢性病 (CKD) 缺铁的常见治疗方法.
- 铁脱脂盐酸 (FDI) 和铁糖盐酸 (FCM) 是现代的静脉注射铁配方,具有相似的疗效.
- FCM与低酸盐血症有关,可能由纤维细胞生长因子23 (FGF23) 介导.
研究的目的:
- 为了比较FDI和FCM对非透析依赖的CKD患者FGF23水平的影响.
- 调查FDI和FCM对酸盐,维生素D,甲状腺类激素和骨周转标记物的影响.
主要方法:
- 一个单中心,双盲,随机对照试验 (ExplorIRON-CKD) 涉及26名非透析依赖的CKD患者 (3a-5阶段) 缺铁.
- 患者接受了FDI或FCM (1:1比),在基线时服用1000毫克铁,并在1个月后服用500-1000毫克铁.
- 测量FGF23,酸盐,维生素D,PTH和骨周转率标志物在输液后多个时间点进行了测量,最多为输液后3个月.
主要成果:
- 与外国直接投资相比,FCM管理导致完整的FGF23大幅增加.
- 与外国直接投资集团相比,FCM组的酸盐含量下降幅度要大得多.
- 与FCM一起观察到1,25(OH) 2维生素D的较大减少和骨周转指标的显著变化,但没有FDI.
结论:
- 在非透析依赖的CKD患者中,FCM对FGF23表现出与FDI相比的差异效应.
- 这些与FCM相关的FGF23变化可能会导致维生素D下降和骨周转变的改变.
- 需要进一步的研究来阐明静脉注射铁化合物之间的这些差异的临床影响.
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