腹膜透析患者的贫血诊治现状

Current status in the diagnosis and treatment of anemia in patients on peritoneal dialysis

在我国,长期腹膜透析患者大约占所有维持性透析患者的15%,腹膜透析人群中肾性贫血的纠正率约40%。与血液透析患者相同,目前指南推荐腹膜透析患者肾性贫血治疗的靶目标为≥115g/L且<130g/L,但有证据提示腹膜透析人群的靶目标上限可能高于血液透析患者。肾性贫血的治疗历程经历了输血、红细胞生成刺激剂、铁剂3个阶段,直至近年,进入了低氧诱导因子脯氨酰羟化酶抑制剂(hypoxia-inducible factor prolyl hydroxylase inhibitor,HIF-PHI)通路干预治疗的新时代,为肾性贫血的治疗开拓了全新的理念。不同的治疗方式有相应的适应证和副作用,应根据患者的情况个体化选择。

In China,maintenance peritoneal dialysis(PD)is used in about 15%of the maintenance dialysis patients.Renal anemia is successfully treated in only 40%of the PD patients.The target hemoglobin level for PD population recommended by the international guidelines is≥115g/L and<130g/L,similar to the target level for hemodialysis patients.However,many evidences have showed that the target of upper hemoglobin level should be higher in PD patients than in hemodialysis patients.The management of renal anemia has experienced three stages:blood transfusion,erythropoietin stimulator and iron supplements.Recently,the hypoxia-inducible factor prolyl hydroxylase inhibitor(HIF-PHI)is introduced,providing a new era of treatment on renal anemia.Clinically,different treatment modalities have different indications and side effects,and individualized strategy based on conditions of the patients should be carried out.