Deak Andras T, Troppan Katharina, Rosenkranz Alexander R
Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 27, 8036 Graz, Austria.
Clinical Division of Haematology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 38, 8036 Graz, Austria.
Eur J Intern Med. 2016 Dec;36:13-19. doi: 10.1016/j.ejim.2016.08.036. Epub 2016 Sep 15.
Anemia is a common complication of cancer and chronic kidney disease (CKD) associated with decreased physical performance as well as poor prognosis for life expectancy. Renal and cancer-induced anemia share common features regarding pathogenesis and therapeutic strategies. It is typically treated with iron substitution, erythropoiesis-stimulating agents (ESA) and in refractory cases with red blood cell transfusions. However, studies of the past few years unveiled numerous setbacks in the use of ESAs. These included a higher risk of cerebrovascular events and increased mortality without the improvement of cardiovascular outcomes in patients with CKD. Moreover, particularly negative results were observed in patients with previous cancer history under ESA therapy. These unfavorable findings have forced the clinicians to reevaluate the management of renal anemia. This led to decrease of ESA usage, while iron substitution and alternative therapeutic options gained more significance. Iron supplementation is also accompanied with certain risks ranging from gastrointestinal complications to severe allergic reactions and increased rate of infections. Furthermore, the evaluation of the long-term safety of excessive iron therapy is still lacking, especially in CKD patients with cancer. In the absence of these clinical studies, this review aims to summarize the currently available therapeutic strategies in anemia management of CKD patients with concomitant cancer.
贫血是癌症和慢性肾脏病（CKD）的常见并发症，与身体机能下降以及预期寿命预后不良相关。肾性贫血和癌症相关性贫血在发病机制和治疗策略方面具有共同特征。其通常采用铁剂替代、促红细胞生成素（ESA）进行治疗，难治性病例则采用红细胞输血治疗。然而，过去几年的研究揭示了ESA使用中的诸多问题。这些问题包括CKD患者发生脑血管事件的风险更高、死亡率增加且心血管结局未得到改善。此外，接受ESA治疗的既往有癌症病史的患者观察到了特别负面的结果。这些不良发现促使临床医生重新评估肾性贫血的管理。这导致ESA使用减少，而铁剂替代和其他治疗选择变得更为重要。铁剂补充也伴随着一定风险，从胃肠道并发症到严重过敏反应以及感染率增加。此外，目前仍缺乏对过量铁剂治疗长期安全性的评估，尤其是在合并癌症的CKD患者中。在缺乏这些临床研究的情况下，本综述旨在总结目前CKD合并癌症患者贫血管理中可用的治疗策略。
