Division of Nephrology, Department of Medicine at Gulhane School of Medicine, Ankara, Turkey.
Blood Purif. 2011;32(3):220-5. doi: 10.1159/000328037. Epub 2011 Aug 9.
Anemia is inevitable as chronic kidney disease (CKD) advances. With the advent of erythropoietin-stimulating agents (ESAs), considerable improvement has been achieved in the management of anemia. However, some patients show a reduced response to ESAs.
Many factors affect the response to ESA treatment. CKD is now considered as an inflammatory disorder and this understanding led to the recognition of the central role of inflammation in ESA resistance. Inflammation is related to untoward outcomes, including atherosclerosis and anemia, in the CKD population. Furthermore, recognition of deleterious effects of proinflammatory markers at different levels of erythropoiesis led to a change in the name of 'anemia of chronic disease' to anemia of inflammation.
The discovery of hepcidin as the major controller of iron metabolism in anemia of inflammation answered many questions regarding the interaction of erythropoietin, iron and bone marrow. Hepcidin production in the liver is driven by three major factors: inflammation, iron overload and anemia/hypoxia. Hepcidin levels are increased in patients with CKD due to the interaction of many factors; a comprehensive understanding of these pathways is thus critical in the effort to alleviate anemia of inflammation and ESA resistance.
In this review, we discussed the epidemiology, determinants and consequences of anemia of inflammation in CKD patients with special emphasis on the central role of hepcidin along with molecular pathways driving its production.
随着慢性肾脏病（CKD）的进展，贫血是不可避免的。随着促红细胞生成素刺激剂（ESA）的出现，贫血的治疗得到了很大的改善。然而，一些患者对 ESA 的反应降低。
许多因素影响 ESA 治疗的反应。CKD 现在被认为是一种炎症性疾病，这种认识导致了炎症在 ESA 抵抗中的核心作用的认识。炎症与 CKD 人群中的不良后果有关，包括动脉粥样硬化和贫血。此外，认识到促炎标志物在不同的红细胞生成水平上的有害作用，导致将“慢性疾病性贫血”的名称更改为“炎症性贫血”。
铁调素作为炎症性贫血中铁代谢的主要调节剂的发现，回答了许多关于促红细胞生成素、铁和骨髓相互作用的问题。肝脏中铁调素的产生受三个主要因素驱动：炎症、铁过载和贫血/缺氧。由于许多因素的相互作用，CKD 患者的铁调素水平升高；因此，全面了解这些途径对于缓解炎症性贫血和 ESA 抵抗至关重要。
在这篇综述中，我们讨论了 CKD 患者炎症性贫血的流行病学、决定因素和后果，特别强调了铁调素的核心作用以及驱动其产生的分子途径。
