Indranil Dasgupta, Corinne Isnard Bagnis, Matteo Floris, Hans Furuland, Daniel Gallego Zurro, Loreto Gesualdo, Nathalie Heirman, Roberto Minutolo, Antonello Pani, José Portolés, Christian Rosenberger, José Emilio Sánchez Alvarez, Pablo Ureña Torres, Raymond C Vanholder, Christoph Wanner
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引用次数: 0
Abstract
Anaemia is common in chronic kidney disease (CKD) and has a significant impact on quality of life (QoL), work productivity, and outcomes. Current management includes oral or intravenous iron and erythropoiesis-stimulating agents (ESAs), to which hypoxia inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) have been recently added, increasing the available therapeutic options. In randomised controlled trials, only intravenous iron improved cardiovascular outcome, while some ESAs were associated with increased adverse cardiovascular events. Despite therapeutic advances, several challenges and unmet needs remain in the current management of anaemia of CKD. In particular, clinical practice does not include an assessment of QoL, which prompted a group of European nephrologists and representatives of patient advocacy groups to revisit the current approach. In this consensus document, the authors propose a move towards a more holistic, personalised, and long-term approach, based on existing evidence. The focus of treatment should be on improving QoL without increasing the risk of adverse cardiovascular events, and tailoring management strategies to the needs of the individual. In addition, the authors discuss the suitability of a currently available anaemia of CKD-specific-health-related QoL measure for inclusion in the routine clinical management of anaemia of CKD. The authors also outline the logistics and challenges of incorporating such a measure into electronic health records and how it may be used to improve QoL for people with anaemia of CKD.
贫血是慢性肾脏病(CKD)的常见病,对生活质量(QoL)、工作效率和预后有重大影响。目前的治疗方法包括口服或静脉注射铁剂和红细胞生成刺激剂(ESAs),最近又增加了缺氧诱导因子脯氨酰羟化酶抑制剂(HIF-PHIs),从而增加了可用的治疗选择。在随机对照试验中,只有静脉注射铁剂能改善心血管预后,而一些 ESAs 则会增加不良心血管事件。尽管在治疗方面取得了进展,但目前在治疗慢性肾脏病贫血方面仍存在一些挑战和未满足的需求。特别是,临床实践并不包括对 QoL 的评估,这促使一组欧洲肾病专家和患者权益组织的代表重新审视当前的方法。在这份共识文件中,作者们根据现有证据提出了一种更加全面、个性化和长期的方法。治疗的重点应该是在不增加不良心血管事件风险的前提下改善患者的生活质量,并根据个人需求制定相应的管理策略。此外,作者还讨论了目前可用的 CKD 贫血特异性健康相关 QoL 测量方法是否适合纳入 CKD 贫血的常规临床管理。作者还概述了将这种测量方法纳入电子健康记录的后勤工作和挑战,以及如何利用它来改善慢性肾脏病贫血患者的 QoL。
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About the Journal
Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.