Rostoker Guy, Hummel Aurélie, Chantrel François, Ryckelynck Jean-Philippe
Service de néphrologie et de dialyse, hôpital privé Claude-Galien, générale de santé, 20, route de Boussy-Saint-Antoine, 91480 Quincy-sous-Sénart, France.
Service de néphrologie et de dialyse adultes, hôpital Necker-enfants malades, 149, rue de Sèvres, 75015 Paris, France.
Nephrol Ther. 2014 Jul;10(4):221-7. doi: 10.1016/j.nephro.2014.02.005. Epub 2014 Jun 26.
The Kidney Disease Improving Global Outcomes (KDIGO)-2012 on the treatment of anemia emit suggestions (which differ from recommendations) based on a scientific evidence of low level. The first rule is no harm; physicians must take into account the profile of the patient and its associated morbidities and remember on the potential risks to begin a treatment by erythropoiesis stimulating agents (ESA) (thrombosis of arteriovenous fistula, hypertension, stroke). All correctable causes of anemia other than erythropoietin deficiency should be actively sought. It is necessary to individualize the treatment by ESA and assess the clinical improvement expected. The ESA will be used in the following way: initiate at 10 g/dL of hemoglobin level with the aim of 11.5 g/dL, without exceeding 13 g/dL. In case of ESA resistance, it seems suitable to assess the risks and benefits of ESA versus blood transfusion. The ERBP-2013 have endorsed the KDIGO-2012 except the proposals dealing with the treatment by IV iron. The use of intravenous iron must be more cautious in the future taking into account the results of a recent French study published in the American Journal of Medicine showing the high frequency of iron overload at quantitative hepatic MRI among haemodialysis patients receiving iron IV following the current guidelines. It is appropriate to use oral iron in first intention as recommended by the ANSM (French Drug Agency) in a recent information note and respect the dosage regimen of the label. The realization of a quantitative hepatic MRI to evaluate iron overload and monitor the treatment by iron IV must also be considered on a case by case basis.
改善全球肾脏病预后组织（KDIGO）-2012关于贫血治疗的建议（与推荐不同）基于低水平的科学证据。首要原则是无害；医生必须考虑患者的情况及其相关疾病，并牢记开始使用促红细胞生成素刺激剂（ESA）进行治疗的潜在风险（动静脉内瘘血栓形成、高血压、中风）。应积极寻找除促红细胞生成素缺乏之外所有可纠正的贫血原因。有必要对ESA治疗进行个体化，并评估预期的临床改善情况。ESA将按以下方式使用：在血红蛋白水平为10 g/dL时开始，目标是达到11.5 g/dL，不超过13 g/dL。如果出现ESA抵抗，评估ESA与输血的风险和益处似乎是合适的。欧洲肾脏最佳实践组织（ERBP）-2013认可了KDIGO-2012，但关于静脉铁剂治疗的建议除外。考虑到最近发表在美国《医学杂志》上的一项法国研究结果，即按照当前指南接受静脉铁剂治疗的血液透析患者在肝脏定量MRI检查中铁过载的频率很高，未来静脉铁剂的使用必须更加谨慎。按照法国药品安全局（ANSM）在最近一份信息通报中的建议，首选口服铁剂是合适的，并应遵守标签上的给药方案。还必须根据具体情况考虑进行肝脏定量MRI检查以评估铁过载并监测静脉铁剂治疗。
