Piotr Bartnicki, Mariusz Stepien, Jacek Rysz
Department of Nephrology, Hypertension and Family Medicine, Zeromski Street 113, 90-596 Lodz. Poland.
Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Lodz. Poland.
Curr Pharm Biotechnol. 2017;18(4):303-308. doi: 10.2174/1389201018666170127104801.
Chronic kidney disease (CKD) is an important health problem, because of unsuccessful outcomes such as CKD progression to end stage renal disease and high risk of cardiovascular disease (CVD). Anemia, associated with CKD, is considered a non-traditional risk factor for CVD which may contribute to faster CKD progression. Anemia treatment with erythropoiesis-stimulating agents (ESAs) seems to exert non-hematopoietic effects on different tissues and organs, including cardiovascular system and kidneys. On the other hand, clinical use of high doses of short-acting ESAs and higher target hemoglobin level were associated with higher risk of CVD. Literature data indicate the usefulness of long-acting ESAs in treatment of anemia in non-dialysis CKD patients. In particular, continuous erythropoietin receptor activator seems to be a good choice in these patients because of its efficiency, safety and monthly administration. Continuous but slower erythropoietin receptor activation, using methoxy polyethylene glycol-epoetin beta (MPG-EPO), administered once a month, slowly corrects anemia without exceeding the recommended hemoglobin level. An overview of the available literature may suggest nephroprotective and cardiovascular protective effects of MPG-EPO. It seems possible that anemia treatment with a novel ESAs, MPG-EPO in early stages of CKD may reduce CVD risk in these patients and delay CKD progression. This review of available literature evaluates the correlation between continuous erythropoietin receptor activation using MPG-EPO and CKD progression and CVD risk in non-dialysis CKD patients.
慢性肾脏病（CKD）是一个重要的健康问题，因为会出现诸如CKD进展至终末期肾病等不良后果以及心血管疾病（CVD）的高风险。与CKD相关的贫血被认为是CVD的非传统风险因素，可能会导致CKD进展加快。使用促红细胞生成素（ESA）治疗贫血似乎会对包括心血管系统和肾脏在内的不同组织和器官产生非造血作用。另一方面，高剂量短效ESA的临床应用以及较高的目标血红蛋白水平与CVD的较高风险相关。文献数据表明长效ESA在治疗非透析CKD患者贫血方面的有效性。特别是，持续促红细胞生成素受体激活剂似乎是这些患者的一个不错选择，因为它有效、安全且每月给药一次。使用甲氧基聚乙二醇化促红细胞生成素β（MPG-EPO）每月给药一次，持续但缓慢地激活促红细胞生成素受体，可在不超过推荐血红蛋白水平的情况下缓慢纠正贫血。现有文献的综述可能提示MPG-EPO具有肾脏保护和心血管保护作用。在CKD早期使用新型ESA即MPG-EPO治疗贫血似乎有可能降低这些患者的CVD风险并延缓CKD进展。这篇现有文献综述评估了使用MPG-EPO持续激活促红细胞生成素受体与非透析CKD患者的CKD进展及CVD风险之间的相关性。
