LIJEČENJE ANEMIJE KRONIČNE BUBREŽNE BOLESTI U PREDIJALIZNOJ FAZI

Erythropoiesis-stimulating agents (ESAs) administered either subcutaneously (sc.) or intravenously (iv.), along with iv. or oral iron therapy, are currently the cornerstones for treating anemia in patients with chronic kidney disease (CKD). Multiple factors are involved in the pathogenesis of anemia in CKD: iron deficiency, inadequate production of erythropoietin (Epo), hepcidin and hypoxia-inducible factors (HIFs). Patients with CKD are prone to iron deficiency (absolute and functional). In this study, we compared the efficacy and safety profile of oral and intravenous iron with erythropoietin beta (subcutaneously in a dose of 4000-6000 IU every week) for the treatment of iron deficiency anemia in 43 non dialysis patients (ND-CKD) with the confirmed diagnosis of iron deficiency anemia (A) at Merkur University Hospital. Exclusion criteria were patients on dialysis or transplantation, with heart failure, secondary hyperparathyroidism, malignancy, thromboembolism, gastrointestinal bleeding, hsCRP >5 mg/L, patients taking medicines that suppress Epo production, and uncontrolled resistant hypertension. Patients were divided into groups on intravenous iron in doses of 1000 mg every month and oral daily intake of iron (ferrous fumarate 350 mg). Iron supplementation was administrated in order to achieve serum ferritin 200-500 mg/L. Hemoglobin (Hb) was checked at the beginning and after 12 months in both groups. Paired sample t-test was applied for comparison of results. The mean level of iron at the beginning in M/F was 9.7/7.9±0.28/0.31 and after 12 months 10.7/8.94±0.27/0.43 μmol/L. In the treatment groups, the mean Hb level was 9.19±0.84 g/dL (A) and 9.72±0.95 g/ dL (B). The mean increase in Hb was 10.65±0.97 g/dL (A) and 10.42±1.22 g/dL (B) at 12 months (p20%. Srednja razina vrijednosti željeza na početku iznosila je u M/F 9,7/7,9±0,28/0,31, dok je na kraju studije bila 10,7/8,94±0,27/0,43 μmol/L. Razina hemoglobina (Hb) je na početku iznosila 9,19±0,84 g/dL (skupina A) i 9,72±0,95 g/dL (skupina B). Na kraju praćenja došlo je u obje skupine do porasta razine Hb u odnosu na početne vrijednosti: 10,65±0,97 g/dL (skupina A) i 10,42±1,22 g/ dL (skupina B) (p