Lea Janice P, Norris Keith, Agodoa Lawrence
Department of Medicine, Renal Division, Emory University, Atlanta, Georgia 30308, USA.
Am J Nephrol. 2008;28(5):732-43. doi: 10.1159/000127981. Epub 2008 Apr 24.
Chronic kidney disease (CKD) is a serious threat to African-American public health. In this population CKD progresses to end-stage renal disease (ESRD) at quadruple the rate in Caucasians. Factors fueling progression to ESRD include diabetes and hypertension, which show high prevalences and accelerated renal damage in African- Americans, as well as possible nutritional, socioeconomic, and genetic factors. Anemia, a common and deleterious complication of CKD, is more prevalent and severe in African-American than Caucasian patients at each stage of the disease. Proactive management of diabetes, hypertension, anemia, and other complications throughout the course of CKD can prevent or delay disease progression and alleviate the burden of ESRD for the African-American community. Currently, African-Americans with CKD are less likely than Caucasian patients to receive anemia treatment before and after the onset of dialysis. Although African-Americans often require higher doses of erythropoiesis-stimulating agents, this may result from late treatment initiation, lower hemoglobin levels, or the presence of comorbidities such as diabetes and inflammation, although racial differences in response cannot be excluded. This review explores racial-specific challenges and potential solutions in renal anemia management to improve outcomes in African-American patients.
慢性肾脏病(CKD)对非裔美国公众健康构成严重威胁。在这一人群中,CKD进展为终末期肾病(ESRD)的速度是白种人的四倍。促使疾病进展至ESRD的因素包括糖尿病和高血压,这两种疾病在非裔美国人中患病率高且肾脏损害加速,此外还可能包括营养、社会经济和遗传因素。贫血是CKD常见且有害的并发症,在疾病的各个阶段,非裔美国患者比白种人患者更为普遍和严重。在CKD病程中对糖尿病、高血压、贫血及其他并发症进行积极管理,可预防或延缓疾病进展,减轻非裔美国人群体的ESRD负担。目前,患有CKD的非裔美国人在透析开始前后接受贫血治疗的可能性低于白种人患者。尽管非裔美国人通常需要更高剂量的促红细胞生成素,但这可能是由于治疗开始较晚、血红蛋白水平较低或存在糖尿病和炎症等合并症,不过也不能排除种族反应差异。本综述探讨了肾性贫血管理中种族特异性挑战及潜在解决方案,以改善非裔美国患者的治疗效果。