three basics in treating kidney disease anemia

 CKD anemia treatment

Anemia of chronic kidney disease (CKD) in particular, the most common dialysis patients, is also one of the major complications. In recent years, clinical studies have shown that the quality of life in patients with anemia often decrease the prevalence of cardiovascular disease and mortality increased significantly, seriously affecting the prognosis of patients with CKD.

 Treatment of anemia in patients with CKD, mainly in three aspects:
 ① supplement erythropoiesis stimulating agents (erythropoiesis-stimulating agents, ESA), such as recombinant erythropoietin (rHuEPO), darbepoetin α, etc;
 ② active iron to ensure blood supply of raw materials;
 ③ detect and correct a variety of other factors that promote or influence CKD anemia (a variety of inflammation, infection, bleeding, metabolic acidosis, carnitine deficiency, protein malnutrition, etc.).

 In general, the correct application of ESA and iron, is the foundation or basic measures CKD anemia treatment, but not all of the content, and sometimes the effect is minimal, indicating that there is still a "third party" (and other factors) involved. In recent years, ESA, iron metabolism and "other factors" in the study of many new developments are. Keep abreast of these developments, the correct guidance of CKD anemia therapy, to improve the quality of life and survival in patients with CKD, are of great significance.

 A grasp CKD anemia treatment target, correct and standardize application ESA

 Treatment of renal anemia treatment target on target, EBPG think should Hb> 110g / L, for without complications (cardiovascular disease, diabetes) patients with Hb not set an upper limit. Recently, the 2007 US K / DOQI guidelines consider Hb should be up to 110 ~ 120g / L, should not exceed 130g / L. Chinese Medical Association credits kidney disease expert consensus (2010 Revision) Hb target target for 110 ~ 120g / L. In summary, Hb target> 110g / L has become a consensus, if less than this value, the quality of life for patients is poor, prone to cardiovascular events, mortality increases. As Hb target ceiling, currently considered inappropriate> 130g / L, otherwise, the risk of adverse events threaten life may be significantly increased. The different characteristics of the old and new products currently known ESA ESA are mainly three types, of which the first two categories have been used clinically:
 ① recombinant erythropoietin (rHuEPO), the most commonly used, has been in clinical use for 20 years;
 ② long-acting ESA: including darbepoetin α (molecular weight 37,000) and continuous erythropoietin receptor agonist (continuous erythropoietin receptor activator, CERA), etc;
 ③ oral type ESA: such as hypoxia-inducible factor (hypoxia-inducible factor, HIF) stabilizers (stablizers) or HIF prolyl hydroxylase (PHD) inhibitor, FG-2216 and FG-4592, after the completion of clinical trials may market.

 ESA ESA therapy at different stages of treatment can be divided into the correction period (Hb rise for the period) and maintenance phase (Hb after standard) treatment. With rHuEPO, for example, the amount of correction of the initial period, and should be based on the patient's Hb level, Hb target, Hb growth rate and the clinical condition to decide, choose subcutaneous or intravenous administration. The initial dose is generally injected subcutaneously 50 ~ 150IU / (kg.w), to Hb rise month 10 ~ 20g / L as target. rHuEPO dosing frequency depends on CKD staging, clinical condition, effectiveness, ESA type, low frequency administration is more convenient, especially for non-hemodialysis patients. rHuEPO short half-life, should normally be administered 2-3 times a week, 1-2 times a week to maintain the period of administration.