慢性肾脏病贫血与心血管疾病

Chronic kidney disease,renal anemia and cardiovascular disease

慢性肾脏病(CKD)是心血管疾病(CVD)的独立危险因素,而贫血又进一步增加CKD患者CVD的风险。“心-肾-贫血综合征”的概念应运而生,指出了三者共存并相互影响的关系。改善CKD患者贫血有助于减低CVD风险,但还应注意把控合理的血红蛋白(Hb)靶目标数值、避免过高Hb带来的血栓事件,同时在需要使用大剂量促红细胞生成素(EPO)或静脉铁剂时应积极寻找影响药物效果的潜在因素并纠正,以避免过度使用上述药物带来的潜在CVD风险增加。低氧诱导因子-脯氨酰羟化酶抑制剂(HIF-PHI)为新一代治疗肾性贫血的药物,其通过生理性升高EPO、改善EPO受体及减少铁调素而纠正贫血,同时还通过下游多种低氧反应元件基因改善糖脂代谢,有望在纠正贫血的同时带来更多的心血管获益。此类药物进入临床时间尚短,还需要更大量的来自真实世界的临床数据进行评判。

CKD is an independent risk factor for CVD,while anemia further increases the CVD risk for CKD patients.Under this circumstance,the concept of“cardio-renal-anemia syndrome”has emerged,indicating the coexistence and interaction relationship among them.Although improvement of anemia is helpful in decreasing CVD risk,we should also keep an eye on controlling Hb level to a rational target to avoid the thrombotic events related to excessively high Hb level.When a high dosage of EPO or intravenous iron supplements is needed in clinic,clinician should search for potential factors that may affect the effect of the drugs and try to correct them,in order to avoid the potential CVD risks raised by overuse of these agents.HIF-PHI is a new-generation drug for renal anemia which can correct anemia by increasing EPO within physiological range,improving EPO-receptor and reducing hepcidin level,etc.It can also improve glucose and lipid metabolism by regulating a variety of downstream hypoxic response element genes at the same time.Based on these,HIFPHI is expected to show additional cardiovascular benefits besides correcting anemia.Because it is only a short period since HIF-PHI is introduced into clinic,we still need more real-world clinical data to make an impartial judgment of the effect of HIF-PHI on CVD.