Department of Nephrology, Dialysis and Renal Transplant, A Manzoni Hospital, Lecco, Italy.
Blood Purif. 2013;36(1):37-40. doi: 10.1159/000350584. Epub 2013 May 25.
Following the publication of the TREAT study, the treatment of anemia in patients with chronic kidney disease (CKD) has become much more complicated than before. The nephrologist needs to analyze the individual patient and prescribe the best treatment option for that patient. Treatment individualization has thus become the mainstay of anemia management. This paradigm needs to take into account the hemoglobin (Hb) level at the start and during erythropoiesis-stimulating agent (ESA) therapy, ESA dose, patient comorbidities and concomitant iron therapy. All these factors are strictly interrelated. Caution is suggested when using ESA at high dose, especially in patients with comorbidities and/or in those who are hyporesponsive to treatment. According to KDIGO guidelines, Hb levels should not exceed the value of 11.5 g/dl during ESA therapy. Recently, iron therapy has received growing attention in an effort to use the lowest possible dose of ESA. However, the long-term risk in maintaining CKD patients with very high ferritin values is still unknown.
随着 TREAT 研究的发表，慢性肾脏病（CKD）患者的贫血治疗变得比以往更加复杂。肾病学家需要分析个体患者的情况，并为该患者开出最佳的治疗方案。因此，个体化治疗已成为贫血管理的主要方法。这种模式需要考虑起始时和红细胞生成刺激剂（ESA）治疗期间的血红蛋白（Hb）水平、ESA 剂量、患者合并症和同时进行的铁剂治疗。所有这些因素都是严格相关的。在使用高剂量 ESA 时应谨慎，尤其是在有合并症和/或对治疗反应不佳的患者中。根据 KDIGO 指南，ESA 治疗期间 Hb 水平不应超过 11.5 g/dl。最近，铁剂治疗受到越来越多的关注，以尽量减少 ESA 的使用剂量。然而，维持 CKD 患者铁蛋白值非常高的长期风险仍不清楚。
