Covic Adrian, Nistor Ionut, Donciu Mihaela-Dora, Dumea Raluca, Bolignano Davide, Goldsmith David
Nephrology Department, Faculty of Medicine, University of Medicine and Pharmacy 'Gr. T. Popa', Iasi, Romania.
Am J Nephrol. 2014;40(3):263-79. doi: 10.1159/000366025. Epub 2014 Oct 15.
The effect of anemia correction on kidney function in chronic kidney disease (CKD) patients remains unclear. As 19-40% of patients with CKD receive an erythropoiesis-stimulating agent (ESA), this is a potentially important consideration.
We conducted a systematic review and meta-analysis of randomized trials to January 1, 2014 in adult patients with CKD stages 1 to 4.
randomized controlled trials of at least 2 months duration. Patients were allocated to ESA versus placebo, no treatment, or different ESA doses with the purpose of achieving a higher versus a lower hemoglobin target. The analyzed outcomes were the need for renal replacement therapy, doubling of serum creatinine, change in GFR (ml/min), mortality and withdrawal of treatment due to adverse events. A total of 19 trials (n = 8,129 participants with CKD stage 1-4) were reviewed. There was no difference in the risk of end-stage kidney disease (RR, 0.97 [CI 0.83-1.20], 17 trials, 8,104 participants), change in GFR (Mean Difference [MD] -0.45 [-2.21, 1.31], 9 trials, 1,848 participants) or withdrawal of treatment due to adverse events (RR, 1.18 [CI 0.77-1.81], 10 trials, n = 1,958 participants) for patients at higher hemoglobin (Hb) targets. Furthermore, no statistically significant differences in mortality (Risk Ratio [RR] 1.10 [CI 0.90-1.35], 16 trials, n = 8,082 participants) were observed. Key Messages: There is no evidence that ESA treatment affects renal function in patients with CKD. Use of these agents should not therefore be influenced by considerations about influencing CKD progression.
慢性肾脏病（CKD）患者贫血纠正对肾功能的影响仍不明确。由于19%至40%的CKD患者接受促红细胞生成素（ESA）治疗，这是一个潜在的重要考量因素。
我们对截至2014年1月1日的成年1至4期CKD患者的随机试验进行了系统评价和荟萃分析。
持续时间至少2个月的随机对照试验。患者被分配接受ESA与安慰剂、不治疗或不同剂量ESA治疗，目的是实现较高与较低的血红蛋白目标。分析的结局包括肾脏替代治疗需求、血清肌酐翻倍、肾小球滤过率（GFR，ml/min）变化、死亡率以及因不良事件导致的治疗退出。共审查了19项试验（n = 8129名1至4期CKD参与者）。较高血红蛋白（Hb）目标的患者在终末期肾病风险（RR，0.97 [CI 0.83 - 1.20]，17项试验，8104名参与者）、GFR变化（平均差[MD] -0.45 [-2.21, 1.31]，9项试验，1848名参与者）或因不良事件导致的治疗退出（RR，1.18 [CI 0.77 - 1.81]，10项试验，n = 1958名参与者）方面无差异。此外，未观察到死亡率有统计学显著差异（风险比[RR] 1.10 [CI 0.90 - 1.35]，16项试验，n = 8082名参与者）。关键信息：没有证据表明ESA治疗会影响CKD患者的肾功能。因此，这些药物的使用不应受影响CKD进展相关考量因素的影响。
