New options for the anemia of chronic kidney disease

IF 19.3 2区 医学 Q1 UROLOGY & NEPHROLOGY Kidney International Supplements Pub Date : 2017-12-01 DOI:10.1016/j.kisu.2017.09.002
Daniel W. Coyne , David Goldsmith , Iain C. Macdougall
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引用次数: 39

Abstract

Anemia is a common complication of chronic kidney disease. Use of erythropoiesis-stimulating agents (ESA) has been a mainstay of treatment since 1990. A series of large trials demonstrated that ESAs have serious safety problems, including increasing cardiovascular and thrombotic events, and death. Analyses suggest high pharmacologic doses of ESAs, rather than the highly achieved hemoglobin, may mediate harm. Hypoxia-inducible factor (HIF) activators stimulate endogenous erythropoietin production and enhance iron availability. In early clinical trials, these oral agents appear to be capable of replacing ESA therapy and minimizing the need for i.v. iron therapy for chronic kidney disease–related anemia, while having other potentially advantageous actions. Large phase 3 trials are underway with several HIF activators. This commentary reviews trends in anemia management, the safety issues related to our present therapies, the role of HIF in regulating erythropoiesis, and the diverse actions of HIF activators.

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慢性肾脏疾病贫血的新选择
贫血是慢性肾脏疾病的常见并发症。自1990年以来,使用促红细胞生成剂(ESA)一直是主要的治疗方法。一系列大型试验表明,esa存在严重的安全性问题,包括增加心血管和血栓事件以及死亡。分析表明,高药理学剂量的esa,而不是高达到的血红蛋白,可能介导伤害。缺氧诱导因子(HIF)激活剂刺激内源性促红细胞生成素的产生,提高铁的可用性。在早期临床试验中,这些口服药物似乎能够替代ESA治疗,并最大限度地减少对慢性肾病相关性贫血的静脉铁治疗的需要,同时具有其他潜在的有利作用。几种HIF活化剂正在进行大规模的3期试验。这篇评论综述了贫血管理的趋势,与我们目前的治疗相关的安全性问题,HIF在调节红细胞生成中的作用,以及HIF激活剂的多种作用。
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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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