Eisen in der Therapie der Anämie bei Nierenkrankheit

Zusammenfassung

Eisenmangel ist ein wesentlicher Faktor, der bei chronischer Nierenerkrankung (CKD) zur Anämie beiträgt und die Lebensqualität einschränkt. Während die orale Eisensubstitution einfach durchführbar ist, erreicht man das Therapieziel vielfach nur sehr langsam. Niedrige Eisenresorptionsquoten bei Menschen mit CKD machen die Präparate wenig attraktiv, zusätzlich schränken gastrointestinale Nebenwirkungen die Adhärenz ein. Intravenöse Eisenpräparate sind in vielen Fällen deutlich effizienter, nebenwirkungsarm und sicher anwendbar; bei renaler Anämie soll ein Substratmangel behoben sein, bevor andere Medikamente zur Behandlung der Anämie gegeben werden. Im Jahr 2025 wird die aktualisierte Leitlinie der KDIGO zum Management der Anämie bei CKD erwartet. Wir zeigen Eckpunkte der vorab online publizierten Review-Fassung auf und legen aktuelle Konzepte der Diagnostik des Eisenmangels sowie der Eisensubstitutionstherapie dar.

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