Renal Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
Heart Fail Clin. 2010 Jul;6(3):347-57. doi: 10.1016/j.hfc.2010.02.001.
Anemia resulting from iron and erythropoietin deficiencies is a common complication of advanced chronic kidney disease (CKD). This article covers major advances in our understanding of anemia in patients with CKD, including newly discovered regulatory molecules, such as hepcidin, to innovative intravenous iron therapies. The use of erythropoiesis-stimulating agents (ESA) in the treatment of anemia has undergone seismic shift in the past 3 years as a result of adverse outcomes associated with targeting higher hemoglobin levels with these agents. Potential mechanisms for adverse outcomes, such as higher mortality, are discussed. Despite the disappointing experience with ESAs, there is a tremendous interest in other novel agents to treat anemia in CKD. Lastly, while awaiting updated guidelines, the authors outline their recommendations on how to best manage patients who are anemic and have CKD.
铁和促红细胞生成素缺乏导致的贫血是晚期慢性肾脏病（CKD）的常见并发症。本文涵盖了我们对 CKD 患者贫血的理解方面的主要进展，包括新发现的调节分子，如铁调素，以及创新的静脉铁治疗方法。在过去 3 年中，由于与使用这些药物将血红蛋白水平靶向更高相关的不良结局，治疗贫血时使用促红细胞生成素刺激剂（ESA）发生了巨大变化。讨论了与不良结局（如死亡率更高）相关的潜在机制。尽管 ESA 的经验令人失望，但人们对其他新型药物治疗 CKD 贫血仍有极大的兴趣。最后，在等待更新指南的同时，作者概述了他们关于如何最好地管理贫血和 CKD 患者的建议。
