Grabe Darren W
Albany Nephrology Pharmacy Group, Albany College of Pharmacy, Albany, NY 12208, USA.
Am J Health Syst Pharm. 2007 Jul 1;64(13 Suppl 8):S8-14; quiz S23-5. doi: 10.2146/ajhp070182.
The National Kidney Foundation (NKF) clinical practice recommendations for treating anemia in chronic kidney disease (CKD) and the dosing, route and frequency of administration, efficacy, and safety of currently available and investigational drug therapies for anemia in patients with CKD, including the erythropoietin-stimulating agents (ESAs) iron replacement, and adjuvants, are described.
The NKF recommendations for ESA use are general and include dosing based on the measured and target hemoglobin concentrations, the rate of increase in hemoglobin, and clinical circumstances, with the route and frequency of administration determined by the CKD stage, treatment setting, efficacy, and ESA class. A serum ferritin concentration of 100-500 ng/mL is the target during oral and intravenous (i.v.) iron therapy for predialysis and peritoneal dialysis patients, but use of the i.v. route of administration and a target serum ferritin concentration of 200-500 ng/mL is recommended for hemodialysis patients by NKF. Iron deficiency and inflammation are possible causes of inadequate response to ESAs. The safety profile of epoetin alfa and darbepoetin alfa are similar, but the longer half-life of darbepoetin alfa permits administration on a once-monthly basis in patients with CKD and anemia. Extended dosing of CERA also appears safe and effective in dialysis patients with CKD. Several investigational anemia therapies with a variety of mechanisms of action are in development.
Efforts by the NKF to update their clinical practice recommendations provide clinicians with insight into the optimal therapeutic approach to treating anemia in patients with CKD. Clinical research has resulted in the development of new therapeutic modalities to improve outcomes in patients with CKD and anemia.
描述了美国国家肾脏基金会（NKF）关于治疗慢性肾脏病（CKD）贫血的临床实践建议，以及CKD患者目前可用和正在研究的贫血药物治疗的给药剂量、途径和频率、疗效及安全性，包括促红细胞生成素刺激剂（ESAs）、铁剂补充剂和辅助药物。
NKF关于使用ESAs的建议较为宽泛，包括根据测得的和目标血红蛋白浓度、血红蛋白的升高速率及临床情况进行给药，给药途径和频率由CKD分期、治疗环境、疗效及ESA类别决定。对于未透析和腹膜透析患者，口服和静脉注射铁剂治疗期间的血清铁蛋白浓度目标为100 - 500 ng/mL，但NKF建议血液透析患者采用静脉注射途径给药，血清铁蛋白浓度目标为200 - 500 ng/mL。缺铁和炎症可能是对ESAs反应不足的原因。阿法依泊汀和达贝泊汀α的安全性相似，但达贝泊汀α的半衰期较长，允许在CKD和贫血患者中每月给药一次。连续使用CERA对CKD透析患者似乎也安全有效。几种具有多种作用机制的贫血治疗药物正在研发中。
NKF更新其临床实践建议的努力为临床医生提供了关于治疗CKD患者贫血的最佳治疗方法的见解。临床研究已促成新治疗方式的开发，以改善CKD和贫血患者的治疗效果。
