Bárány Peter, Müller Hans-Joachim
Division of Renal Medicine, Department of Clinical Science, Intervention, and Technology, Karolonska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Nephrol Dial Transplant. 2007 Jun;22 Suppl 4:iv10-iv18. doi: 10.1093/ndt/gfm161.
The introduction of erythropoiesis-stimulating agents radically advanced the management of anaemia associated with chronic kidney disease (CKD). The European Best Practice Guidelines recommend that most patients with CKD achieve a target haemoglobin (Hb) >/=11 g/dl to reduce the risk of adverse outcomes. The optimal upper Hb level has not been determined and will likely vary among CKD patient populations. Recently reported studies show evidence that normalising Hb ( approximately 14 g/dl) in CKD may increase the risk of adverse events and puts attention to the importance of the upper Hb target. Most patients can achieve target Hb levels with proper treatment. However, recent studies have demonstrated that while average Hb levels may fall within desired targets, the Hb levels of many patients are not being adequately controlled, i.e. their Hb levels are not consistently maintained within a specified target range over time. Furthermore, data indicate that failing to control Hb levels over time may increase the risk of adverse outcomes, including mortality. This review will discuss the challenges in controlling Hb in the CKD patient population, particularly in haemodialysis patients. Factors that affect Hb control over time will be considered, as well as the clinical criteria for its assessment. Although challenging, control of Hb is manageable and has potential clinical benefits.
促红细胞生成素的引入极大地推动了慢性肾脏病（CKD）相关贫血的管理。欧洲最佳实践指南建议，大多数CKD患者应达到血红蛋白（Hb）≥11 g/dl的目标，以降低不良结局的风险。最佳的Hb上限水平尚未确定，且可能因CKD患者群体而异。最近报道的研究表明，使CKD患者的Hb正常化（约14 g/dl）可能会增加不良事件的风险，并凸显了Hb上限目标的重要性。大多数患者通过适当治疗可以达到Hb目标水平。然而，最近的研究表明，虽然平均Hb水平可能落在期望的目标范围内，但许多患者的Hb水平并未得到充分控制，即随着时间推移，他们的Hb水平并未持续维持在特定的目标范围内。此外，数据表明，随着时间推移未能控制Hb水平可能会增加包括死亡在内的不良结局风险。本综述将讨论CKD患者群体，尤其是血液透析患者在控制Hb方面面临的挑战。将考虑影响Hb长期控制的因素以及评估Hb的临床标准。尽管具有挑战性，但Hb的控制是可行的，并且具有潜在的临床益处。
