腎性貧血に投与した3種類の静注用鉄剤の治療効果の比較検討 Comparative study of the therapeutic effect of 3 intravenous iron preparations in patients with renal anemia

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血液透析患者の貧血の治療には静注用鉄剤と遺伝子組み換えヒトエリスロポエチン(rHuEPO)の投与が重要である.鉄剤については効果に差がないと一般的に考えられている.しかし,当院では静注用鉄剤を含糖酸化鉄からシデフェロンに変えた時に変化がおこることを経験している.認められた変化は予想を上回る血清フェリチン値の上昇,鉄剤の投与量およびrHuEPO投与量の減少であった.今回,同一患者に3種類の静注用鉄剤(含糖酸化鉄,シデフェロン,コンドロイチン硫酸鉄コロイド)をそれぞれ1年間投与して各鉄剤投与期間のヘマトクリット(Ht)値,ヘモグロビン(Hb)値,鉄剤投与量,血清フェリチン濃度,平均赤血球容積(MCV),rHuEPO投与量について比較検討した.対象は慢性維持透析患者86例である.なお,rHuEPOの投与はHt値を指標に当院で設定しているrHuEPO投与量に従って次週の投与量を決定した.静注用鉄剤の投与量は毎月1回測定したフェリチン濃度を基準に決めた.その結果,観察期間中を通して,平均Htはほぼ30%を維持できていたが,その中でもシデフェロン投与期が最も高かった.さらに,シデフェロン投与期では,血清フェリチン濃度の有意な上昇と,MCVの増大が認められ,Hb値も最も高かった.また,フェリチン濃度の維持に必要な鉄投与量はシデフェロンが最も少なく,rHuEPO投与量は,含糖酸化鉄と比しシデフェロン投与で有意に少なかったが,コンドロイチン硫酸鉄コロイド投与とは差がなかった.このように,シデフェロンは少ない投与量でも有効利用され,最も血清フェリチン濃度を上昇させた.血清フェリチン濃度の上昇時期とrHuEPO製剤投与量の低下時期には重なりがみられ,血清フェリチン濃度の確実な上昇がrHuEPO製剤の投与量の減量を可能にしたと考えられた.

Intravenous iron preparations and rHuEPO are important in the treatment of anemia in hemodialysis patients. It is generally considered that all intravenous iron preparations are the same in terms of effect. However, we have found differences between saccharated ferric oxide and cideferron. Specifically, a larger than anticipated increase in serum ferritin was observed with a dose reduction in the iron preparation and rHuEPO. In this study, three iron preparations (saccharated ferric oxide, cideferron, iron chondroitin sulfate) were administered for one year each for a total of three years to 86 patients undergoing chronic dialysis, and various parameters (Ht, Hb, iron preparation dose, serum ferritin, MCV, rHuEPO dose) during each treatment period were compared. The same patients were used throughout the study. Each week, the rHuEPO dose for the following week was determined in accordance with our established dosage nomogram based on hematocrit (Ht) value. Iron dose was based on ferritin concentration, measured monthly. It was shown that the mean Ht concentration was maintained at about 30% during the 3-year period, with the highest levels were observed during treatment with cideferron. During this period, hemoglobin levels were also the highest and a significant increase in serum ferritin as well as increased mean corpuscular volume (MCV) were observed. To maintain the ferritin concentration, cideferron required the lowest dose. During treatment with cideferron, the rHuEPO dose was significantly lower than that during treatment with saccharated ferric oxide but the same as that during treatment with iron chondroitin sulfate. In summary, despite administering a lower dose, cideferron was most effective in increasing serum ferritin. Since the increase in serum ferritin coincided with a decreased rHuEPO dose, we concluded that a definite increase in serum ferritin levels could be achieved by rHuEPO dosage reduction.

収録刊行物

  • 日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy  

    日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy 41(4), 237-243, 2008-04-28 

    The Japanese Society for Dialysis Therapy

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各種コード

  • NII論文ID(NAID)
    10021274401
  • NII書誌ID(NCID)
    AN10432053
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    13403451
  • NDL 記事登録ID
    9500028
  • NDL 雑誌分類
    ZS39(科学技術--医学--皮膚科学・泌尿器科学)
  • NDL 請求記号
    Z19-1413
  • データ提供元
    CJP書誌  NDL  J-STAGE 
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