Panwar Bhupesh, Gutiérrez Orlando M
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.
Semin Nephrol. 2016 Jul;36(4):252-61. doi: 10.1016/j.semnephrol.2016.05.002.
Dysregulated iron homeostasis plays a central role in the development of anemia of chronic kidney disease (CKD) and is a major contributor toward resistance to treatment with erythropoiesis-stimulating agents. Understanding the underlying pathophysiology requires an in-depth understanding of normal iron physiology and regulation. Recent discoveries in the field of iron biology have greatly improved our understanding of the hormonal regulation of iron trafficking in human beings and how its alterations lead to the development of anemia of CKD. In addition, emerging evidence has suggested that iron homeostasis interacts with bone and mineral metabolism on multiple levels, opening up new avenues of investigation into the genesis of disordered iron metabolism in CKD. Building on recent advances in our understanding of normal iron physiology and abnormalities in iron homeostasis in CKD, this review characterizes how anemia related to disordered iron metabolism develops in the setting of CKD. In addition, this review explores our emerging recognition of the connections between iron homeostasis and mineral metabolism and their implications for the management of altered iron status and anemia of CKD.
铁稳态失调在慢性肾脏病（CKD）所致贫血的发生发展中起核心作用，并且是促红细胞生成素治疗抵抗的主要原因。要理解其潜在的病理生理学，需要深入了解正常的铁生理学和调节机制。铁生物学领域的最新发现极大地增进了我们对人体铁转运激素调节的理解，以及其改变如何导致CKD贫血的发生。此外，新出现的证据表明，铁稳态在多个层面与骨和矿物质代谢相互作用，为研究CKD中铁代谢紊乱的发生机制开辟了新途径。基于我们对正常铁生理学以及CKD中铁稳态异常的最新认识进展，本综述阐述了在CKD背景下与铁代谢紊乱相关的贫血是如何发生的。此外，本综述探讨了我们对铁稳态与矿物质代谢之间联系的新认识，以及它们对CKD中铁状态改变和贫血管理的意义。
