Department of Nephrology, Dialysis and Renal Transplant, Ospedale A. Manzoni, Via dell'Eremo 9, 23900 Lecco, Italy.
Expert Opin Pharmacother. 2012 Mar;13(4):495-503. doi: 10.1517/14656566.2012.658369. Epub 2012 Feb 2.
Anemia, a frequent and early complication of chronic kidney disease (CKD), not only impairs quality of life but is also an independent risk factor for adverse cardiovascular outcomes. Erythropoiesis-stimulating agents (ESAs), together with iron, are the main therapeutic tool to correct anemia in CKD patients nowadays.
Following a literature search on PubMed using 'anemia', 'hemoglobin', 'erythropoietin' and 'target' as keywords, we critically analyzed ESAs, looking in depth at their distinct characteristics and possible advantages in the clinical setting. The introduction of biosimilars into the European market is also discussed. Finally, we reviewed current evidence about the optimal hemoglobin (Hb) target to aim at in CKD patients receiving ESA and possible treatment indications by international guidelines or health institutions.
All ESAs are effective agents to correct anemia. Newer molecules have been developed with an improved pharmacokinetic and pharmacodynamic profile. This translates into longer administration intervals than can be a true advantage, mainly for CKD patients not receiving dialysis. Short-acting epoetins, including biosimilars, should be administered more often, but can be cheaper than last-generation molecules. Following publication of the TREAT study, there is considerable confusion about the optimal Hb target to aim for in CKD patients using ESA. While waiting for Kidney Disease Global Outcome (KDIGO) guidelines recommendations, we believe that the general approach to anemia management in CKD patients should still aim at Hb levels of 11 - 12 g/dl; however, it is wise to use caution in those patients who are hyporesponsive to ESA or have a previous history of stroke or malignancies.
贫血是慢性肾脏病（CKD）的常见早期并发症，不仅会降低生活质量，还是不良心血管结局的独立危险因素。促红细胞生成素刺激剂（ESAs）与铁剂一起，是目前纠正 CKD 患者贫血的主要治疗手段。
通过在 PubMed 上使用“贫血”“血红蛋白”“促红细胞生成素”和“目标”作为关键字进行文献检索，我们对 ESAs 进行了批判性分析，深入探讨了它们在临床环境中的独特特征和可能的优势。还讨论了生物类似药在欧洲市场的引入。最后，我们回顾了关于接受 ESA 治疗的 CKD 患者的最佳血红蛋白（Hb）目标以及国际指南或医疗机构可能的治疗指征的现有证据。
所有 ESAs 都是纠正贫血的有效药物。已经开发出具有改善的药代动力学和药效学特征的新型分子。这转化为更长的给药间隔，这可能是一个真正的优势，主要适用于未接受透析的 CKD 患者。包括生物类似物在内的短效促红细胞生成素应更频繁地给药，但可能比上一代分子更便宜。在 TREAT 研究发表后，对于使用 ESA 的 CKD 患者，Hb 目标的最佳值存在相当大的混淆。在等待肾脏病全球倡议（KDIGO）指南建议的同时，我们认为 CKD 患者贫血管理的一般方法仍应将 Hb 水平目标设定为 11-12g/dl；然而，对于对 ESA 反应不佳或有卒中或恶性肿瘤病史的患者，谨慎使用是明智的。
