Department of Medicine, Hospital of St. Raphael, Yale School of Medicine, New Haven, CT 06511, USA.
Clin J Am Soc Nephrol. 2012 Feb;7(2):354-7. doi: 10.2215/CJN.11961111. Epub 2012 Jan 19.
Erythropoietic stimulating agents (ESAs) such as erythropoietin have been used for decades to treat the anemia of CKD. Clinical practice guidelines suggest target hemoglobin levels >10 g/dl, and average Hb levels have risen from 9.6 to 12.0 g/dl. Several studies have shown trends for higher mortality and myocardial infarction, higher BP, increased vascular access thrombosis, and strokes in patients treated to target Hb ≥13 g/dl. Patients with profound anemia suffer from symptoms of fatigue, poor energy, weakness, and shortness of breath. Such symptoms reported directly by patients, or patient-reported outcomes (PROs), may be a valuable tool to target ESA treatment in anemic CKD patients. Studies show that improvements in anemia correlate with improvements in these PRO domains in some individuals. We propose that instead of Hb targets for all patients, treatment of anemia should be directed toward improving the areas of patient-perceived quality of life most affected by anemia. PROs can be used by individual patients to prioritize the risks and benefits of ESA treatment. Patients, along with their physicians, can examine Hb level in the context of patients' perception of their quality of life and use ESAs judiciously to improve these perceptions.
几十年来，促红细胞生成素（Erythropoietic stimulating agents，ESAs）等药物一直被用于治疗 CKD 患者的贫血。临床实践指南建议目标血红蛋白水平＞10 g/dl，而平均 Hb 水平已从 9.6 升至 12.0 g/dl。多项研究表明，对于治疗目标 Hb≥13 g/dl 的患者，死亡和心肌梗死、血压升高、血管通路血栓形成和中风的风险呈上升趋势。严重贫血的患者会出现疲劳、精力差、虚弱和呼吸急促等症状。这些直接由患者报告的症状或患者报告的结局（PROs），可能是针对贫血性 CKD 患者进行 ESA 治疗的有价值工具。研究表明，在某些个体中，贫血的改善与这些 PRO 领域的改善相关。我们建议，不是针对所有患者设定 Hb 目标，而是应该针对最受贫血影响的患者感知生活质量的领域来治疗贫血。PROs 可由个别患者用于优先考虑 ESA 治疗的风险和获益。患者及其医生可以根据患者对自身生活质量的感知来检查 Hb 水平，并明智地使用 ESAs 来改善这些感知。
