Overview of anemia associated with chronic renal disease: primary and secondary mechanisms.
Overview of anemia associated with chronic renal disease: primary and secondary mechanisms.
复制标题
与慢性肾病相关的贫血概述：主要和次要机制。
作者：
Paganini Ep
在大多数慢性肾衰竭患者中，红细胞通常正常的低增殖性贫血的发展损害了维持性透析治疗的成功，特别是血液透析。贫血可能是血液透析过程本身的并发症，伴随着相关的失血和对氧转运功能的轻度影响。然而，慢性透析患者贫血的主要原因是红细胞生成减少。导致红细胞生成减少的最重要的机制涉及红细胞生成素（EPO）的低于正常水平的产生。EPO的肾输出量不足或可能是尿毒症抑制剂对EPO作用的抑制可能导致红细胞生成减少。其他因素，如缺铁、甲状旁腺功能亢进、全身感染和铝中毒可能导致某些患者贫血。溶血增加是慢性透析患者贫血的一个相对温和的因素，可能与蛋白质代谢产物的保留、脾功能亢进、低磷酸盐血症、药物或受影响患者的其他状况有关。贫血有几种传统的治疗选择：输血;铁，维生素B12或叶酸补充剂（如有指征）;腹膜透析;甲状旁腺切除术;和雄激素管理。这些治疗方法中没有一种被证明是令人满意的，有些治疗方法，如输血和雄激素治疗，会带来风险，并有严重的副作用。一种相对较新的方法，基因工程促红细胞生成素（r-HuEPO; EPOGEN，AMGEN Inc，Thousand Oaks，CA）的给药，已被发现在临床试验中有效治疗贫血。患者表现出改善的心脏功能以及提高生活质量，高血压似乎是最严重的副作用r-HuEPO治疗。
The development of hypoproliferative anemia with generally normocytic red blood cells in most patients with chronic renal failure impairs the success of maintenance dialysis therapy, particularly hemodialysis. Anemia can be a complication of the hemodialysis procedure itself, with its associated blood losses and mild effect on oxygen transport functioning. However, the primary cause of anemia in the chronic dialysis patient is decreased erythropoiesis. The most important mechanism leading to decreased erythropoiesis involves the production of subnormal levels of erythropoietin (EPO). Insufficient nephric output of EPO or, possibly, suppression of the effect of EPO by uremic inhibitors may cause this decreased erythropoiesis. Other factors, such as iron deficiency, hyperparathyroidism, systemic infections, and aluminum toxicity may contribute to anemia in some patients. Increased hemolysis, a comparatively mild factor in the anemia of chronic dialysis patients, may be related to retention of protein metabolism products, hypersplenism, hypophosphatemia, drugs, or other conditions in affected patients. There are several traditional treatment options for anemia: transfusions; iron, vitamin B12, or folic acid supplementation when indicated; a change to peritoneal dialysis; parathyroidectomy; and administration of androgens. None of these treatments have proved satisfactory, and some, such as transfusions and androgen therapy, pose risks and have serious side effects. A comparatively new approach, administration of genetically engineered erythropoietin (r-HuEPO; EPOGEN, AMGEN inc, Thousand Oaks, CA), has been found effective in treating anemia in clinical trials. Patients have shown improved cardiac performance as well as enhanced quality of life, and hypertension appears to be the most serious side effect of r-HuEPO therapy.