缺铁在慢性肾脏病中很常见,甚至在透析阶段之前。它是非透析慢性肾脏病患者发病率和死亡率的独立因素。在慢性肾病期间，铁缺乏定义为转铁蛋白饱和度<20％和/或血清铁蛋白<100μg/L。在法国,约一半的非透析慢性肾脏病患者存在绝对铁缺乏(转铁蛋白饱和度<20%,血清铁蛋白<100μg/L)和/或功能性铁缺乏(转铁蛋白饱和度<20%,血清铁蛋白>100μg/L)。尽管如此,铁缺乏通常不调查。事实上,超过60%的肾脏科医师每年至少不评估一次铁状态.此外,铁缺乏很少治疗：只有12％的患者口服或静脉注射铁。早期发现和治疗是基本的，应该是系统的。为了帮助改善非透析慢性肾脏病患者缺铁的管理,我们提出了一种算法，该算法考虑了当前的建议和文献中的最新数据。最初的血液检查需要测量血红蛋白浓度，转铁蛋白饱和度和血清铁蛋白。转铁蛋白饱和度<20％可以诊断为铁缺乏，血清铁蛋白水平指向绝对或功能缺乏。这两个值的结合使得适应治疗成为可能，特别是在口服铁无效的炎症环境中。
Iron deficiency is very common in chronic kidney disease, even before the dialysis stage. It is an independent factor of morbidity and mortality in patients with non-dialysis chronic kidney disease. During chronic kidney disease, iron deficiency is defined by a transferrin saturation <20% and/or a serum ferritin <100 μg/L. In France, about half of non-dialysis chronic kidney disease patients have absolute iron deficiency (transferrin saturation <20% and serum ferritin <100 μg/L) and/or functional iron deficiency (transferrin saturation <20% and serum ferritin >100 μg/L). Despite this, iron deficiency is usually not investigated. In fact, more than 60% of nephrologists do not assess iron status at least once a year. In addition, iron deficiency is rarely treated: only 12% of patients are prescribed oral or intravenous iron. Early detection and treatment are fundamental and should be systematic. In order to help improve the management of iron deficiency among non-dialysis chronic kidney disease patients, we propose an algorithm that takes into account current recommendations and the most recent data from the literature. Initial blood test requires the measurement of hemoglobin concentration, transferrin saturation and serum ferritin. A transferrin saturation <20% establishes the diagnosis of iron deficiency and the serum ferritin level points towards an absolute or functional deficiency. The combination of both values makes it possible to adapt the treatment, particularly in an inflammatory context where oral iron is not effective.
