Del Vecchio Lucia
Dipartimento di Nefrologia, Dialisi e Trapianto Renale, Ospedale ''A. Manzoni'', Lecco, Italy.
G Ital Nefrol. 2009 Nov-Dec;26(6):686-94.
The development of recombinant human erythropoietin and its introduction into the market in the late 1980s has significantly improved the quality of life of patients with chronic kidney disease (CKD) and reduced the need for blood transfusions. Starting from a cautious target, a progressive increase in the recommended hemoglobin levels has been observed over the years, in parallel with an increase in the obtained levels. This trend has gone together with the publication of findings of observational studies showing a relationship between the increase in hemoglobin levels and a reduction in the mortality risk, with the conduction of clinical trials testing the effects of complete anemia correction, and with the compilation of guidelines on anemia control in CKD patients by scientific societies and organizations. In the last two years, evidence of a possible increase in the mortality risk in those patients who were randomized to high hemoglobin levels has resulted in a decrease in the upper limit of the recommended Hb target to be obtained with erythropoietin stimulating agents (ESA), and consequently in a narrowing of the target range. Comparison of guidelines on anemia control in CKD patients is an interesting starting point to discuss single recommendations, strengthen their importance, or suggest new topics of research to fill up important gaps in knowledge.
重组人促红细胞生成素的研发及其于20世纪80年代末投放市场，显著改善了慢性肾脏病（CKD）患者的生活质量，并减少了输血需求。从一个谨慎的目标开始，多年来观察到推荐的血红蛋白水平逐步提高，同时所达到的水平也在上升。这一趋势伴随着观察性研究结果的发表，这些研究表明血红蛋白水平的升高与死亡风险的降低之间存在关联；伴随着旨在测试完全纠正贫血效果的临床试验的开展；以及伴随着科学协会和组织编写的CKD患者贫血控制指南。在过去两年中，随机分配到高血红蛋白水平的患者中可能存在死亡风险增加的证据，导致促红细胞生成素刺激剂（ESA）所应达到的推荐血红蛋白目标上限降低，从而使目标范围变窄。比较CKD患者贫血控制指南是一个有趣的起点，可用于讨论单项建议、强化其重要性或提出新的研究课题，以填补重要的知识空白。
