Del Vecchio Lucia, Minutolo Roberto
Department of Nephrology and Dialysis, Sant'Anna Hospital, ASST Lariana, 22042 Como, Italy.
Nephrology Division, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy.
J Clin Med. 2021 Feb 18;10(4):839. doi: 10.3390/jcm10040839.
Anemia is a well-known consequence of chronic kidney disease (CKD); it is mainly due to a relative insufficiency of erythropoietin synthesis by the failing kidneys. Over the years, the combination of erythropoiesis stimulating agents (ESA) and iron has become the standard of care of anemia. All ESAs effectively increase hemoglobin (Hb) levels in a substantial percentage of patients. However, in the last decade, their use has been surrounded by safety issues in increased cardiovascular risk, especially when used at high doses in inflamed and hyporesponsive patients. This has led to the definition of a more cautious Hb target. Iron deficiency is very frequent in CKD patients, with a higher frequency in non-dialysis patients. Traditionally, iron supplementation is mostly used as supportive therapy for anemia control. However, the concept is growing that intravenous iron therapy per se could be beneficial in the presence of heart failure. A new class of drugs, prolyl hydroxylase domain (PHD) inhibitors (PHD inhibitors) is becoming available for the treatment of anemia in CKD patients. Theoretically, these agents have a number of advantages, the main ones being that of stimulating the synthesis of endogenous erythropoietin and increasing iron availability. The impact of their future use in clinical practice is still to be defined. Another possible strategy could be targeting serum hepcidin and its related pathways. This possibility is fascinating from the scientific point of view, but at present its development phase is still far from clinical application.
贫血是慢性肾脏病（CKD）的一个众所周知的后果；主要是由于功能衰竭的肾脏促红细胞生成素合成相对不足。多年来，促红细胞生成素刺激剂（ESA）和铁剂联合使用已成为贫血治疗的标准方法。所有的ESA都能使相当比例的患者有效提高血红蛋白（Hb）水平。然而，在过去十年中，它们的使用一直受到心血管风险增加的安全问题困扰，尤其是在炎症状态和反应低下的患者中高剂量使用时。这导致了更谨慎的Hb目标的确定。缺铁在CKD患者中非常常见，非透析患者中更为频繁。传统上，补充铁剂主要用作控制贫血的支持性疗法。然而，越来越多的观念认为，静脉铁剂治疗本身在心力衰竭患者中可能有益。一类新型药物，脯氨酰羟化酶结构域（PHD）抑制剂正可用于治疗CKD患者的贫血。理论上，这些药物有许多优点，主要优点是刺激内源性促红细胞生成素的合成并增加铁的利用率。它们未来在临床实践中的应用影响仍有待确定。另一种可能的策略可能是针对血清铁调素及其相关途径。从科学角度来看，这种可能性很有吸引力，但目前其开发阶段仍远未应用于临床。
