Division of Nephrology, Department of Medicine, Hofstra Northwell School of Medicine, Great Neck, NY.
Division of Nephrology, New York-Presbyterian/Queens, Flushing, NY.
Am J Kidney Dis. 2018 Mar;71(3):423-435. doi: 10.1053/j.ajkd.2017.09.026. Epub 2018 Jan 11.
Anemia is a frequent complication during the later stages of chronic kidney disease. When present, it may cause symptoms such as fatigue and shortness of breath. The pathogenesis of anemia in chronic kidney disease is complex, but a central feature is a relative deficit of erythropoietin. New information has elucidated the critical role of the hypoxia-sensing system in mediating erythropoietin synthesis and release. Iron deficiency is a second important factor in the anemia of chronic kidney disease. New insights into the dynamics of iron metabolism have clarified the role of chronic inflammation and hepcidin as key mediators of impaired iron utilization. In this article, we review the epidemiology, pathobiology, clinical evaluation, and treatment of anemia in chronic kidney disease.
贫血是慢性肾脏病晚期的常见并发症。当发生贫血时，可能会引起疲劳和呼吸急促等症状。慢性肾脏病贫血的发病机制复杂，但一个中心特征是促红细胞生成素相对不足。新的信息阐明了缺氧感应系统在调节促红细胞生成素合成和释放中的关键作用。铁缺乏是慢性肾脏病贫血的第二个重要因素。对铁代谢动力学的新认识阐明了慢性炎症和铁调素作为铁利用受损的关键介质的作用。本文综述了慢性肾脏病贫血的流行病学、病理生物学、临床评估和治疗。
