Borawski Bartłomiej, Malyszko Jacek Stanislaw, Kwiatkowska Marlena, Malyszko Jolanta
Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland.
1st Department of Nephrology and Transplantology, Medical University of Bialystok, 15-540 Bialystok, Poland.
J Clin Med. 2021 Sep 15;10(18):4149. doi: 10.3390/jcm10184149.
Chronic kidney disease (CKD) is one of the fastest-growing major causes of death internationally. Better treatment of CKD and its complications is crucial to reverse this negative trend. Anemia is a frequent complication of CKD and is associated with unfavorable clinical outcomes. It is a devastating complication of progressive kidney disease, that negatively affects also the quality of life. The prevalence of anemia increases in parallel with CKD progression. The aim of this review is to summarize the current knowledge on therapy of renal anemia. Iron therapy, blood transfusions, and erythropoietin stimulating agents are still the mainstay of renal anemia treatment. There are several novel agents on the horizon that might provide therapeutic opportunities in CKD. The potential therapeutic options target the hepcidin-ferroportin axis, which is the master regulator of iron homeostasis, and the BMP-SMAD pathway, which regulates hepcidin expression in the liver. An inhibition of prolyl hydroxylase is a new therapeutic option becoming available for the treatment of anemia in CKD patients. This new class of drugs stimulates the synthesis of endogenous erythropoietin and increases iron availability. We also summarized the effects of prolyl hydroxylase inhibitors on iron parameters, including hepcidin, as their action on the hematological parameters. They could be of particular interest in the out-patient population with CKD and patients with ESA hyporesponsiveness. However, current knowledge is limited and still awaits clinical validation. One should be aware of the potential risks and benefits of novel, sophisticated therapies.
慢性肾脏病（CKD）是全球范围内增长最快的主要死因之一。更好地治疗CKD及其并发症对于扭转这一不良趋势至关重要。贫血是CKD常见的并发症，与不良临床结局相关。它是进展性肾病的一种严重并发症，也会对生活质量产生负面影响。贫血的患病率随着CKD的进展而升高。本综述的目的是总结目前关于肾性贫血治疗的知识。铁剂治疗、输血和促红细胞生成素刺激剂仍然是肾性贫血治疗的主要手段。有几种新型药物即将问世，可能为CKD提供治疗机会。潜在的治疗选择针对铁调素-铁转运蛋白轴，它是铁稳态的主要调节因子，以及骨形态发生蛋白-信号转导和转录激活因子（BMP-SMAD）途径，它调节肝脏中铁调素的表达。抑制脯氨酰羟化酶是一种可用于治疗CKD患者贫血的新治疗选择。这类新型药物可刺激内源性促红细胞生成素的合成并增加铁的可利用性。我们还总结了脯氨酰羟化酶抑制剂对包括铁调素在内的铁参数的影响，以及它们对血液学参数的作用。它们可能对门诊CKD患者和促红细胞生成素刺激剂低反应性患者特别有意义。然而，目前的知识有限，仍有待临床验证。人们应该了解新型复杂疗法的潜在风险和益处。
