Sicherheitsaspekte parenteraler Eisentherapien bei Patienten mit chronischer Niereninsuffizienz

Zusammenfassung

Eisenmangel tritt häufig bei Patienten mit chronischer Niereninsuffizienz auf und lässt sich insbesondere mittels parenteraler Eisensupplementation ausgleichen. Durch frühzeitige Anwendung können durch die Eisentherapie Erythropoese-stimulierenden Substanzen eingespart und eine Anämie effektiv behandelt werden. Die Bewertung des Eisenstatus ist bei Patienten mit CKD erschwert. Die Behandlung sollte nicht ausschließlich Zielwert-orientiert sein, sondern sich auch nach der Therapiedauer und dem Therapieansprechen richten.

Die wesentlichen Sicherheitsaspekte bei parenteralen Eisenpräparaten beziehen sich auf ein mögliches anaphylaktisches Potenzial und die potenzielle Induktion von oxidativem Stress durch die Freisetzung von freiem Eisen. Dennoch kann die parenterale Eisentherapie bei Patienten mit CKD zumeist sicher und nebenwirkungsfrei erfolgen. Hinsichtlich des Sicherheitsprofils der verfügbaren Präparate ist aus der aktuellen Datenlage keine eindeutige Überlegenheit einzelner Präparate zu erkennen. Dextran-haltige Eisenpräparate bilden hier eine Ausnahme, da sie aufgrund zwar seltener aber schwerer Nebenwirkungen ein ungünstigeres Sicherheitsprofil zu haben scheinen. Eine vergleichende Bewertung der Eisenpräparate der dritten Generation mit bisher verfügbaren Präparaten ist aufgrund mangelnder Datenlage nicht möglich. Im Vergleich von Ferumoxytol mit Eisensucrose wurde erstmalig ein Präparat der dritten Generation einem älteren Präparat direkt gegenübergestellt. Aus diesen Daten, den Zulassungsstudien und den experimentellen Daten ergibt sich jedoch kein klarer Hinweis auf eine Überlegenheit der neuen Präparate hinsichtlich des Sicherheitsaspektes.

Abstract

Iron deficiency often occurs in patients with chronic kidney disease and can be effectively treated with parenteral supplementation of iron. In these patients, prompt application of iron therapy can help to reduce the dependence of erythropoietin-stimulating agents and effectively treat anemia. Correct evaluation of iron metabolism in CKD patients can be difficult. Duration of and response to therapy should always be considered while planning parenteral supplementation of iron.

The main safety aspects of parenteral iron preparations relate to their possible anaphylactic potential and the potential induction of oxidative stress due to the release of free iron. However, parenteral iron supplementation is usually safe and without major side effects. Regarding current data, none of the iron preparations is showing definitive superiority. Although uncommon, iron preparations containing dextran can lead to severe side effects, therefore these preparations appear to have an inferior safety profile. Due to limited data, a comparison of third-generation iron preparations with previous preparations is not possible. Recently, for the first time, the third generation iron preparation ferumoxytol has been directly compared to iron sucrose. From this data and others, it remains unclear whether third generation iron preparations show safety-relevant superiority.

Schlüsselwörter

Eisenmangel - chronische Niereninsuffizienz - parenterale Eisentherapie

Keywords

iron deficiency - chronic kidney disease - parenteral iron therapy

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