铁代谢和管理:关注慢性肾脏疾病

IF 19.3 2区 医学 Q1 UROLOGY & NEPHROLOGY Kidney International Supplements Pub Date : 2021-04-01 DOI:10.1016/j.kisu.2020.12.003
Anil K. Agarwal
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引用次数: 21

摘要

贫血在慢性肾脏疾病(CKD)患者中很常见,是铁代谢和红细胞生成失调的结果。Hepcidin是铁可用性的关键调节因子,并在铁补充状态下导致铁的固存。在缺氧和/或铁限制的情况下,hepcidin水平的降低为红细胞生成提供了更大的铁可用性。然而,随着CKD严重程度的增加,hepcidin的肾脏排泄会减少,而在CKD患者中经常出现的炎症条件下,hepcidin的产生会增加,这两种情况都会导致贫血。因此,评估铁的状态在贫血的治疗中是必不可少的。然而,目前用于确定铁的充足供应的实验室测试有许多局限性,包括生物标志物水平的日变化,实验室间缺乏标准化的参考方法,以及炎症的存在造成混淆。此外,目前CKD贫血的治疗模式可能进一步破坏铁稳态;例如,在缺乏补充铁的情况下使用促红细胞生成剂治疗可引起功能性铁缺乏。此外,补充铁可以进一步提高肝磷脂水平。一些新疗法,包括缺氧诱导因子脯氨酰羟化酶抑制剂和hepcidin抑制剂/拮抗剂,已经显示出在CKD贫血中降低hepcidin水平和/或活性的希望,从而确保铁的可用性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Iron metabolism and management: focus on chronic kidney disease

Anemia is common in patients with chronic kidney disease (CKD) and results from the dysregulation of iron metabolism and erythropoiesis. Hepcidin is a key regulator of iron availability and leads to iron sequestration during the state of iron repletion. Decreases in the level of hepcidin in the presence of hypoxia and/or iron limitation allow for greater iron availability for erythropoiesis. However, kidney excretion of hepcidin decreases as the severity of CKD increases, whereas production of hepcidin is increased under inflammatory conditions often present in patients with CKD, both of which contribute to anemia. Assessment of iron status is, therefore, essential in the treatment of anemia. However, current laboratory tests for the determination of the adequate supply of iron have many limitations, including diurnal variation in the levels of biomarkers, lack of standardized reference methods across laboratories, and confounding by the presence of inflammation. In addition, the current treatment paradigm for anemia of CKD can further disrupt iron homeostasis; for example, treatment with erythropoiesis-stimulating agents in the absence of supplemental iron can induce functional iron deficiency. Moreover, supplemental iron can further increase levels of hepcidin. Several novel therapies, including hypoxia-inducible factor prolyl hydroxylase inhibitors and hepcidin inhibitors/antagonists, have shown promise in attenuating the levels and/or activity of hepcidin in anemia of CKD, thus ensuring the availability of iron for erythropoiesis.

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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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