Responsiveness to Erythropoiesis-Stimulating Agents in Chronic Kidney Disease: Does Geography Matter?
Responsiveness to Erythropoiesis-Stimulating Agents in Chronic Kidney Disease: Does Geography Matter?
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DOI：
10.1007/s40265-013-0175-3
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发表时间：
2014-02-01
期刊：
影响因子：
11.5
通讯作者：
Minutolo, Roberto
中科院分区：
文献类型：
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作者：
De Nicola, Luca;Locatelli, Francesco;Minutolo, Roberto
非透析慢性肾脏疾病（CKD）患者中大量高危人群的肾性贫血管理是一个关键问题。特别是，最佳血红蛋白（Hb）治疗目标的定义是有争议的，但全世界的医生和患者都高度支持。最近，国际临床实践指南建议在维持治疗期间延迟启动促红细胞生成素（ESA）和降低Hb靶水平。然而，在达到给定Hb值所需的ESA剂量方面的地理差异可以得到证明，美国患者显示出更高的ESA耐药性患病率。另一方面，非美国患者通常通过低ESA剂量维持较高的Hb范围。这个临界点从来没有被提到过。然而，在美国之外，翻译新指南的限制性建议（基本上是基于美国患者的试验）可能会导致负面影响，例如输血需求增加和生活质量恶化。在这篇文章中，我们根据个人对ESA的反应性的地理差异，对目前关于非透析CKD贫血管理的建议进行了重新评估。
Management of renal anemia in the large and at-risk population of non-dialysis chronic kidney disease (CKD) patients is a critical issue. In particular, definition of the optimal hemoglobin (Hb) target for therapy is controversial but highly warranted by physicians and patients worldwide. Recently, international clinical practice guidelines have recommended delayed initiation of erythropoiesis-stimulating agents (ESA) and lower Hb target levels during maintenance therapy. However, geographical differences in terms of ESA dose needed to achieve a given Hb value can be evidenced, with US patients showing higher prevalence of ESA resistance. On the other hand, non-US patients are often maintained in a higher Hb range by means of low ESA doses. This critical point has never been addressed. Nevertheless, outside of the US, translating the restrictive recommendations of new guidelines, which are essentially based on trials in US patients, can lead to negative effects, such as an increased need for a blood transfusion, and worsening of quality of life. In this article we provide a reappraisal of current recommendations on anemia management in non-dialysis CKD in light of the geographical differences in individual responsiveness to ESA.