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达贝泊汀-α在慢性肾脏病贫血治疗中的应用

Authors
Allen R Nissenson, MD
Shaan Anand, MD
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD
Translators
傅余芹, 主任医师

引言

在慢性肾脏病(chronic kidney disease, CKD)中，贫血是一种极其常见的并发症，可在终末期肾病(end-stage renal disease, ESRD)所致的尿毒症症状发作很久之前出现。当肾小球滤过率(glomerular filtration rate, GFR)降至30mL/min以下时，通常会发生肾功能不全所致的贫血，但在GFR显著较高(如，60mL/min)的患者中也可发生贫血[1]。

如不予治疗，CKD所致的贫血将导致多种生理异常，包括心功能恶化、认知和精神敏锐度减退[2]。也可伴有影响患者常规活动能力的症状，如乏力、虚弱、嗜睡、厌食和睡眠障碍。此外，贫血患者通常精神萎靡而难以应付日常活动或工作[3]。

在CKD患者人群中，贫血也可能是心血管疾病死亡率高的原因之一，因为在这一人群中低血细胞比容(hematocrit, Hct)是死亡的一项独立危险因素。例如，一项研究发现，Hct降低3%，死亡风险增加7%[4]。其原因最可能是发生左心室肥厚(left ventricular hypertrophy, LVH)的倾向增加(参见“终末期肾病患者的心肌功能不全”)。在这种情况下，不对贫血进行治疗的总体结果是心脏重塑不良[5]，而血红蛋白(hemoglobin, Hb)浓度每减少1g/dL，LVH的风险增加6%[6]。 (参见“慢性肾脏病患者的贫血和左心室肥厚”)

美国肾脏病基金会(National Kidney Foundation, NKF)肾脏病预后质量倡议(Kidney Disease Outcome Quality Initiative, K/DOQI)的指南推荐当成年男性血红蛋白低于13.5g/dL，成年女性血红蛋白低于12.0g/dL时，评估CKD患者的贫血原因[2]。在肾脏病患者中，贫血主要是由肾脏产生的促红细胞生成素(erythropoietin, EPO)不足导致的[7]。然而，也可能有其他原因或额外的促发因素，尤其是铁或叶酸缺乏，在治疗贫血之前也需对此进行评估[2,8]。 (参见“慢性肾脏病铁缺乏的诊断”和“Treatment of iron deficiency in nondialysis chronic kidney disease (CKD) patients”和“血液透析患者中铁剂的使用”)

CKD患者EPO的明显缺乏可通过外源性应用红细胞生成刺激剂(erythropoiesis-stimulating agent, ESA)得以纠正。目前在美国有2种此类药物可供使用(参见“非透析慢性肾脏病患者贫血的治疗”和“血液透析患者慢性肾脏病性贫血的促红细胞生成素治疗”)：

             

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Literature review current through: 2017-06 . | This topic last updated: 2015-08-06.
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