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非透析慢性肾脏病患者贫血的治疗

Author
Jeffrey S Berns, MD
Section Editor
Thomas A Golper, MD
Deputy Editor
Alice M Sheridan, MD
Translators
崔昭, 副主任医师

引言

贫血在慢性肾脏病(chronic kidney disease, CKD)患者中十分普遍。贫血是许多肾功能减退相关症状的基础，还与死亡率和住院率增加有关[1-4]。

本文将讨论非透析CKD患者贫血的筛查和治疗。我们对血液透析和腹膜透析患者贫血的筛查和治疗方法将在别处讨论。 (参见“血液透析患者中铁剂的使用”和“促红细胞生成素的皮下给药”)

非透析CKD患者、血液透析患者和腹膜透析患者铁缺乏的治疗将在别处讨论。 (参见“Treatment of iron deficiency in nondialysis chronic kidney disease (CKD) patients”和“血液透析患者中铁剂的使用”和“Treatment of iron deficiency in peritoneal dialysis patients”)

定义

世界卫生组织(World Health Organization, WHO)将贫血定义为：成年男性和绝经后女性的血红蛋白(hemoglobin, Hb)浓度低于13.0g/dL，绝经前女性低于12.0g/dL[5]。 (参见“成年贫血患者的诊断方法”，关于‘血红蛋白/HCT的正常范围’一节)

然而，WHO对贫血的定义并没有指明对CKD患者纠正贫血的目标。因此，即使给予充分治疗，仍有很多CKD患者存在上文定义的贫血。这是由于贫血的治疗需要使用红细胞生成刺激剂(erythropoiesis-stimulating agent, ESA)，而目前多项研究均证实，使用ESA治疗时如以血红蛋白水平的正常值为目标，会增加发生不良结局的风险。 (参见下文‘血红蛋白目标值’)

                 

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Literature review current through: 2017-06 . | This topic last updated: 2017-03-22.
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