慢性肾脏病患者的贫血是由随肾小球滤过率 (GFR) 降低而出现的促红细胞生成素不足所导致的。
通常在 GFR 分类为 G3a/G3b 的 CKD 患者中发现贫血。患者应至少每 6-12 个月接受一次全血细胞计数的筛查,当血红蛋白(Hb)下降到 <100 g/L(<10 g/dL)且出现贫血症状时,可开始考虑使用红细胞生成刺激剂治疗。
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How does two-weekly administration of erythropoiesis-stimulating agents compare with weekly and monthly administration for people with anemia due to chronic kidney disease who are not on dialysis?/cca.html?targetUrl=https://cochranelibrary.com/cca/doi/10.1002/cca.1679/full展示答案
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How does recombinant human erythropoietin compare with placebo/no treatment in people with anemia of chronic kidney disease who do not require dialysis?/cca.html?targetUrl=https://cochranelibrary.com/cca/doi/10.1002/cca.1224/full展示答案
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How do newer continuous erythropoiesis receptor activators compare with older erythropoiesis-stimulating agents in people with anemia of chronic kidney disease?/cca.html?targetUrl=https://cochranelibrary.com/cca/doi/10.1002/cca.1866/full展示答案 Hb 的靶目标值是 100~110 g/L (10~11 g/dL)。[96]KDIGO Anemia Work Group. KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Int Suppl. 2012 Aug;2(4):279-335.
https://kdigo.org/wp-content/uploads/2016/10/KDIGO-2012-Anemia-Guideline-English.pdf
[99]Pfeffer MA, Burdmann EA, Chen CY, et al. A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med. 2009 Nov 19;361(21):2019-32.
http://www.ncbi.nlm.nih.gov/pubmed/19880844?tool=bestpractice.com
[130]Jing Z, Wei-jie Y, Nan Z, et al. Hemoglobin targets for chronic kidney disease patients with anemia: a systematic review and meta-analysis. PLoS One. 2012;7(8):e43655.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0043655
http://www.ncbi.nlm.nih.gov/pubmed/22952731?tool=bestpractice.com
如果患者患有铁缺乏,可给予口服或静脉补充剂。[103]O'Lone EL, Hodson EM, Nistor I, et al. Parenteral versus oral iron therapy for adults and children with chronic kidney disease. Cochrane Database Syst Rev. 2019 Feb 21;(2):CD007857.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007857.pub3/full
http://www.ncbi.nlm.nih.gov/pubmed/30790278?tool=bestpractice.com
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How does intravenous iron compare with oral iron therapy for adults and adolescents with chronic kidney disease?/cca.html?targetUrl=https://www.cochranelibrary.com/cca/doi/10.1002/cca.2550/full展示答案
对于依赖促红细胞生成素刺激剂治疗贫血的 CKD 患者,若 Hb 达到正常值>130 g/L (>13 g/dL),死亡风险和心血管并发症的风险将会升高。[98]Drüeke TB, Locatelli F, Clyne N, et al; CREATE Investigators. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med. 2006 Nov 16;355(20):2071-84.
http://www.ncbi.nlm.nih.gov/pubmed/17108342?tool=bestpractice.com
[97]Singh AK, Szczech L, Tang KL, et al. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med. 2006 Nov 16;355(20):2085-98.
http://www.ncbi.nlm.nih.gov/pubmed/17108343?tool=bestpractice.com
[131]Besarab A, Bolton WK, Browne JK, et al. The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin. N Engl J Med. 1998 Aug 27;339(9):584-90.
https://www.nejm.org/doi/10.1056/NEJM199808273390903
http://www.ncbi.nlm.nih.gov/pubmed/9718377?tool=bestpractice.com
[132]Carrera F, Lok CE, de Francisco A, et al; PATRONUS Investigators. Maintenance treatment of renal anaemia in haemodialysis patients with methoxy polyethylene glycol-epoetin beta versus darbepoetin alfa administered monthly: a randomized comparative trial. Nephrol Dial Transplant. 2010 Dec;25(12):4009-17.
https://academic.oup.com/ndt/article/25/12/4009/1864389
http://www.ncbi.nlm.nih.gov/pubmed/20522670?tool=bestpractice.com
[133]Locatelli F, Aljama P, Canaud B, et al; Anaemia Working Group of European Renal Best Practice (ERBP). Target haemoglobin to aim for with erythropoiesis-stimulating agents: a position statement by ERBP following publication of the Trial to Reduce Cardiovascular Events with Aranesp Therapy (TREAT) study. Nephrol Dial Transplant. 2010 Sep;25(9):2846-50.
https://academic.oup.com/ndt/article/25/9/2846/1942610
http://www.ncbi.nlm.nih.gov/pubmed/20591813?tool=bestpractice.com
慢性病性贫血