Erythropoiesis-stimulating agents in chronic kidney disease: What have we learned in 25 years?

Szu Chun Hung, Yao Ping Lin, Der Cherng Tarng*

*此作品的通信作者

研究成果: Review article同行評審

41 引文 斯高帕斯(Scopus)

摘要

Since the pioneering studies by Eschbach etal in 1987, erythropoiesis-stimulating agents (ESAs) have become the mainstay of anemia therapy in chronic kidney disease (CKD) patients. The introduction of ESAs 25 years ago markedly improved the lives of many patients with CKD, who until then had severe, often transfusion-dependent anemia. However, randomized controlled trials demonstrate an increased risk for cardiovascular events such as stroke, thrombosis, and death at nearly normal hemoglobin concentrations and higher ESA doses in CKD. By contrast, kidney transplant recipients may represent a unique population of CKD patients who may benefit from ESA therapy. This review discusses potential mechanisms involving the erythropoietic and nonerythropoietic effects of ESA treatment and ESA resistance. Further research aimed at elucidating the causal pathways is strongly recommended. Given current knowledge, however, clinical practice should avoid disproportionately high dosages of ESAs to achieve recommended hemoglobin targets, particularly in those with significant cardiovascular morbidity or ESA resistance. The key to CKD anemia management will be individualization of the potential benefits of reducing blood transfusions and anemia-related symptoms against the risks of harm.

原文English
頁(從 - 到)3-10
頁數8
期刊Journal of the Formosan Medical Association
113
發行號1
DOIs
出版狀態Published - 1月 2014

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