Treatment of anemia in difficult-to-manage patients with chronic kidney disease

IF 19.3 2区 医学 Q1 UROLOGY & NEPHROLOGY Kidney International Supplements Pub Date : 2021-04-01 DOI:10.1016/j.kisu.2020.12.006
Ritesh Raichoudhury , Bruce S. Spinowitz
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引用次数: 12

Abstract

The management of anemia of chronic kidney disease (CKD) is often challenging. In particular, for patients with underlying inflammation, comorbid type 2 diabetes or cancer, those hospitalized, and recipients of a kidney transplant, the management of anemia may be suboptimal. Responsiveness to iron and/or erythropoiesis-stimulating agents, the mainstay of current therapy, may be reduced and the risk of adverse reactions to treatment is increased in these difficult-to-manage patients with anemia of CKD. This review discusses the unique patient and disease characteristics leading to complications and suboptimal treatment response. New treatment options in clinical development, such as hypoxia-inducible factor-prolyl hydroxylase (HIF-PH) inhibitors, may be particularly useful for difficult-to-treat patients. In clinical studies, HIF-PH inhibitors provided increased hemoglobin levels and improved iron utilization in anemic patients with non–dialysis-dependent and dialysis-dependent CKD, and preliminary data suggest that HIF-PH inhibitors may be equally effective in patients with or without underlying inflammation. The availability of new treatment options, including HIF-PH inhibitors, may improve treatment outcomes in difficult-to-manage patients with anemia of CKD.

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难治性慢性肾病患者贫血的治疗
慢性肾脏疾病(CKD)贫血的管理往往是具有挑战性的。特别是,对于有潜在炎症、合并症2型糖尿病或癌症、住院和肾移植的患者,贫血的管理可能不是最佳的。在这些难以控制的CKD贫血患者中,对铁和/或促红细胞生成药物的反应性(目前治疗的主要方法)可能会降低,并且治疗不良反应的风险会增加。这篇综述讨论了导致并发症和次优治疗反应的独特患者和疾病特征。临床开发中的新治疗方案,如缺氧诱导因子-脯氨酸羟化酶(HIF-PH)抑制剂,可能对难以治疗的患者特别有用。在临床研究中,HIF-PH抑制剂在非透析依赖性和透析依赖性CKD的贫血患者中提供血红蛋白水平升高和铁利用改善,初步数据表明HIF-PH抑制剂可能对有或没有潜在炎症的患者同样有效。包括HIF-PH抑制剂在内的新治疗方案的可用性可能会改善难以控制的CKD贫血患者的治疗结果。
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来源期刊
Kidney International Supplements
Kidney International Supplements UROLOGY & NEPHROLOGY-
CiteScore
11.80
自引率
0.00%
发文量
13
期刊介绍: Kidney International Supplements is published on behalf of the International Society of Nephrology (ISN) and comes complimentary as part of a subscription to Kidney International. Kidney International Supplements is a peer-reviewed journal whose focus is sponsored, topical content of interest to the nephrology community.
期刊最新文献
Editorial Board Table of Contents Variations in kidney care management and access: regional assessments of the 2023 International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) Update on variability in organization and structures of kidney care across world regions Capacity for the management of kidney failure in the International Society of Nephrology Newly Independent States and Russia region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)
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