Linee Guida per il trattamento dell'anemia nell'insufficienza renale ...

Linee Guida per il trattamento dell’anemia nell’insufficienza renale cronica
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142. Grutzmacher P, Ehmer B, Limbach J, et al. Treatment with
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overload and hyperparathyroidism. Blood Purif 1990; 8: 279-84.
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Appendice 1
Compartimenti e metabolismo del ferro
1.1 - Bilancio del ferro nei pazienti uremici in trattamento
con epoetina
La quantità totale di ferro contenuta nell’organismo umano è
intorno a 4 g (adulto di 70 Kg): 3 g nelle sedi funzionali dove
viene utilizzato (principalmente Hb), 1 g nelle sedi di deposito
(principalmente ferritina), 3-4 mg nella sede di trasporto (transferrina).
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with erythropoietin requirements. Am J Kidney Dis 2001; 38
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glomerular ultrafiltration in the rat. VIII. Effects of hematocrit.
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of hematocrit by erythropoietin on renal damage in
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of recombinant human erythropoietin treatment in pre-dialysis
patients: result of a multicenter study. J Artif Organs 1998; 21:
12-8.
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by erythropoietin therapy retards the progression of chronic renal
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hypoxic culture conditions and suppression of the effect of natriuretic
peptides. Cell Biol Int 1997; 21: 175-80.
165. Berns J, Rudnick M, Cohen R, Bower J, Wood B. Effects of normal
hematocrit on ambulatory blood pressure in epoietin-treated
hemodialysis patients with cardiac disease. Kidney Int 1999; 56:
253-60.
166. De Marchi S, Cecchin E, Falletti E, et al. Long-term effects of
erythropoietin therapy on fistula stenosis and plasma concentrations
of PDGF and MCP-1 in hemodialysis patients. J Am Soc
Nephrol 1997; 8: 1147-56.
167. Bellizzi V, De Nicola L, Ames P, et al. Fetal proteins and chronic
treatment with low-dose erythropoietin. J Lab Clin Med 1997;
129: 193-9.
168. Hastka J, Lasserre JJ, Schwarzbeck A, et al. Central role of zinc
protoporphyrin in staging iron deficiency. Clin Chem 1994; 40:
768-73.
169. Braun J, Hammerschmidt M, Schreiber M, et al. Is zinc protoporphyrin
an indicator of iron-deficient erythropoiesis in maintenance
haemodialysis patients? Nephrol Dial Transplant 1996; 11:
492-7.
L’ingresso del ferro nell’organismo avviene a livello del
duodeno e della prima parte del digiuno, dove il 10% del ferro
contenuto negli alimenti (prevalentemente animali) viene
assorbito. Diete ricche di ferro come quella americana (circa
15 mg/die) consentono un apporto giornaliero di 1-1.5 mg/die
di ferro. È molto frequente un apporto alimentare insufficiente.
Si calcolano più di 800 milioni di persone carenti di ferro,
soprattutto neonati, bambini e adolescenti, donne in età fertile
e in gravidanza. Condizioni ricorrenti di perdite aumentate
sono: il ciclo mestruale (15-40 mg ogni ciclo normale, con un
fabbisogno aumentato da 1 a 4-5 mg/die), stillicidio ematico
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