Novak James E, Szczech Lynda A
Division of Nephrology and Hypertension, Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan 48202, USA.
Curr Opin Nephrol Hypertens. 2008 Nov;17(6):580-8. doi: 10.1097/MNH.0b013e32830c488d.
Recent trial data have resulted in a reevaluation of the management of anemia in chronic kidney disease, including the use of erythropoiesis-stimulating agents, intravenous iron, and novel pharmaceuticals. In this review, we evaluate the latest research on anemia management in chronic kidney disease.
Clinical trials of erythropoiesis-stimulating agents indicate that targeting the complete correction of anemia in patients with chronic kidney disease results in a greater risk of morbidity and mortality despite improved hemoglobin and quality of life. Conversely, intravenous iron has been found effective and relatively well tolerated in treating anemia in chronic kidney disease, even in patients with elevated ferritin. New agents to manage anemia, including long-acting erythropoietin derivatives, are also in active development.
Erythropoiesis-stimulating agents should be used to target hemoglobin 11-12 g/dl in patients with chronic kidney disease. Intravenous iron may be beneficial for patients with hemoglobin less than 11 g/dl and transferrin saturation less than 25% despite elevated ferritin (500-1200 ng/ml). An upcoming placebo-controlled trial of darbepoetin should help to define the role of erythropoiesis-stimulating agents in chronic kidney disease.
近期的试验数据促使对慢性肾脏病贫血的管理进行重新评估，包括促红细胞生成素、静脉铁剂及新型药物的使用。在本综述中，我们评估了慢性肾脏病贫血管理的最新研究。
促红细胞生成素的临床试验表明，尽管血红蛋白及生活质量有所改善，但旨在完全纠正慢性肾脏病患者贫血会导致更高的发病和死亡风险。相反，已发现静脉铁剂在治疗慢性肾脏病贫血方面有效且耐受性相对良好，即使是铁蛋白升高的患者。包括长效促红细胞生成素衍生物在内的新型贫血管理药物也在积极研发中。
慢性肾脏病患者应使用促红细胞生成素将血红蛋白目标值设定为11 - 12 g/dl。尽管铁蛋白升高（500 - 1200 ng/ml），静脉铁剂可能对血红蛋白低于11 g/dl且转铁蛋白饱和度低于25%的患者有益。即将开展的达贝泊汀安慰剂对照试验应有助于明确促红细胞生成素在慢性肾脏病中的作用。
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