Phản ứng với Các Tác Nhân Kích Thích Sinh Hồng Cầu Trong Bệnh Thận Mạn Tính: Địa Lý Có Quan Trọng Không?

Drugs - Tập 74 - Trang 159-168 - 2014
Luca De Nicola1, Francesco Locatelli2, Giuseppe Conte1, Roberto Minutolo1
1Nephrology Division, Second University of Naples, School of Medicine, Naples, Italy
2Alessandro Manzoni Hospital, Lecco, Italy

Tóm tắt

Quản lý thiếu máu thận trong quần thể lớn và có nguy cơ cao của bệnh nhân bệnh thận mạn tính (CKD) không chạy thận là một vấn đề quan trọng. Đặc biệt, định nghĩa về mức hemoglobin (Hb) mục tiêu tối ưu cho điều trị là một vấn đề gây tranh cãi nhưng lại rất cần thiết đối với các bác sĩ và bệnh nhân trên toàn thế giới. Gần đây, các hướng dẫn thực hành lâm sàng quốc tế đã khuyến nghị trì hoãn việc khởi đầu liệu pháp các tác nhân kích thích sinh hồng cầu (ESA) và mức Hb mục tiêu thấp hơn trong quá trình điều trị duy trì. Tuy nhiên, có sự khác biệt địa lý về liều ESA cần thiết để đạt được giá trị Hb nhất định, với bệnh nhân ở Mỹ cho thấy tỷ lệ kháng ESA cao hơn. Ngược lại, bệnh nhân không ở Mỹ thường duy trì ở khoảng Hb cao hơn thông qua việc sử dụng liều ESA thấp. Điểm quan trọng này chưa từng được xem xét. Tuy nhiên, ngoài Mỹ, việc chuyển giao các khuyến nghị hạn chế của các hướng dẫn mới, vốn chủ yếu dựa trên các thử nghiệm với bệnh nhân Mỹ, có thể dẫn đến những tác động tiêu cực, chẳng hạn như tăng nhu cầu truyền máu và làm xấu đi chất lượng cuộc sống. Trong bài viết này, chúng tôi cung cấp một sự xem xét lại các khuyến nghị hiện tại về quản lý thiếu máu trong CKD không chạy thận, xem xét sự khác biệt địa lý trong khả năng đáp ứng cá nhân với ESA.

Từ khóa


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