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Die Nephrologie

Erschienen in:

04.07.2019 | Epoetin alfa | CME

Renale Anämie

verfasst von: Dr. C. C. Haufe

Erschienen in: Die Nephrologie | Ausgabe 4/2019

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Zusammenfassung

Das für die Blutbildung wichtige Hormon Erythropoetin (EPO) wird spätestens ab Stadium CKD 4 einer chronischen Nierenerkrankung („chronic kidney disease“, CKD) vermindert gebildet. Es entwickelt sich eine renale Anämie mit schlechterer Sauerstoffversorgung im Organismus, verminderter Lebensqualität und schlechterer Prognose. 1988 wurde gentechnisch hergestelltes, rekombinantes humanes EPO (rHu-EPO) in die Therapie der renalen Anämie eingeführt. Das rHu-EPO und die nachfolgend entwickelten Substanzen zur Anämiekorrektur werden unter dem Begriff „erythropoesestimulierende Agenzien“ (ESA) zusammengefasst. Für CKD-Patienten liegen die optimalen Hämoglobin(Hb)-Zielwerte einer ESA-Therapie unterhalb des Normbereichs Gesunder. Die KDIGO(Kidney Disease: Improving Global Outcomes)-Leitlinien für Erwachsene empfehlen einen Hb-Zielwert von höchstens 11,5 g/dl (>7,14 mmol/l). Vorausgesetzt wird eine adäquate biologische Verfügbarkeit von Vitamin B₁₂, Folsäure und Eisen.

Clase CM, Kiberd BA, Garg AX (2007) Relationship between glomerular filtration rate and the prevalence of metabolic abnormalities: Results from third national health and nutrition examination survey. Nephron Clin Pract 105:178–184CrossRef

Thomas MC et al (2004) The burden of anaemia in typ 2 diabetes and the role of nephropathie. A cross-sectional audit. Nephrol Dial Transplant 19:1792–1797CrossRef

Fishbane S, Pollack S, Feldman HI et al (2009) Iron indices in chronic kidney disease in the National Health and Nutritional Examination Survey 1988–2004. Clin J Am Soc Nephrol 4:57–61CrossRef

Locatelli F, EBPG II working group (2004) Revised European best practice guidelines for the management of anaemia in patients with chronic renal failure. Nephrol Dial Transplant 19(Suppl 2):ii1–ii47PubMed

National Kidney Foundation (2006) KDOQI clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease. Am J Kidney Dis 47(Suppl 3):S1–S146

Mast AE, Blinder MA, Gronowski AM, Chumley C, Scott MG (1998) Clinical utility of the soluble transferrin receptor and comparison with serum ferritin in several populations. Clin Chem 44:45–51PubMed

KDOQI (2006) Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease. Am J Kidney Dis May 47(5 Suppl 3):11–145

Kalantar-Zadeh K, Kalantar-Zadeh K, Lee GH (2006) The fascinating but deceptive ferritin: To measure it or not to measure it in chronic kidney disease? Clin J Am Soc Nephrol 1:S9–S18CrossRef

Coyne DW, Kapoian T, Suki W et al (2007) Ferric gluconate is highly efficacious in anemic hemodialysis patients with high serum ferritin and low transferrin saturation: Results of the dialysis patients’ response to IV iron with elevated ferritin (DRIVE) study. J Am Soc Nephrol 18:975–984CrossRef

10.

Pollak VE et al (2009) The importance of iron in long-term survival of maintenance hemodialysis patients treated with epoetin-α and intravenous iron: Analysis of 9.5 years of prospectively collected data. BMC Nephrol 10:6CrossRef

11.

Cavill I (2002) Erythropoiesis and iron. Best Pract Res Clin Haematol 15:399–409CrossRef

12.

Macdougall IC (1998) What is the most appropriate strategy to monitor functional iron deficiency in the dialysed patient on EPO therapy? Nephrol Dial Transplant 13:847–849CrossRef

13.

Schaefer RM, Schaefer L (1999) Hypochromic red blood cells and reticulocytes. Kidney Int 55(Suppl 69):S44–S48CrossRef

14.

Andrews NC (2004) Anemia of inflammation: The cytokine-hepcidin link. J Clin Invest 113:1271–1276CrossRef

15.

Pfeffer MA et al (2009) A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med 361:2019–2032CrossRef

16.

Schaefer RM, Schaefer L (1992) Management of iron substitution during r‑HuEPO therapy in chronic renal failure patients. Erythropoiesis 3:71–75

17.

Fishbane S, Frei GL, Maesaka J (1995) Reduction in recombinant human erythropoetin doses by the use of chronic intravenous iron administration. Am J Kidney Dis 26:41–46CrossRef

18.

Eschbach JW (2005) Iron requirements in erythropoetin therapy. Best Pract Res Clin Haematol 18:347–361CrossRef

19.

Alleyne M, Horne MK, Miller JL (2008) Individualized treatment for iron-deficiency anemia in adults. Am J Med 121:943–948CrossRef

20.

Chertow GM, Mason PD, Vaage-Nilsen O, Ahlmen J (2006) Update on adverse drug events associated with parenteral iron. Nephrol Dial Transplant 21(2):378–382CrossRef

21.

Fletes R, Lazarus JM, Gage J et al (2001) Suspected iron dextran-related adverse drug events in hemodialysis patients. Am J Kidney Dis 37:743–749CrossRef

22.

Macdougall IC, Obrador GT (2013) How important is transfusion avoidance in 2013. Nephrol Dial Transplant. https://doi.org/10.1093/ndt/gfs575 CrossRefPubMedPubMedCentral

23.

Drueke TB, Locatelli F, Clyne N et al (2006) CREATE investigators normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med 355:2071–2084CrossRef

24.

Singh AK, Szczech L, Tang KL et al (2006) CHOIR Investigators. Correction of anemia with epoetin α in chronic kidney disease. N Engl J Med 355:2085–2098CrossRef

25.

Besarab A, Bolton WK, Browne JK et al (1998) The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin. N Engl J Med 339:584–590CrossRef

26.

Swedberg K, Young JB, Amand JS et al (2013) Treatment of anemia with Darbepoetin α in systolic heartfailure. N Engl J Med 368(13):1210–1219CrossRef

27.

Srippoli GF, Craig JC, Manno C et al (2004) Hemoglobin targets for the anemia of chronic kidney disease: a meta-analysis of randomized, controlled trials. J Am Soc Nephrol 15:3154–3165CrossRef

28.

Rossert J, McClellan WM, Roger SD et al (2002) Epoetin treatment: What are the arguments to expect a beneficial effect on renal disease progression? Nephrol Dial Transplant 17:359–362CrossRef

29.

Bahlmann FH, de Groot K, Haller H et al (2004) Erythropoetin: Is it more than correcting anaemia? Nephrol Dial Transplant 19:20–22CrossRef

30.

Besarab A, Flaharty KK, Erslev AJ et al (1992) Clinical pharmacology and economics of recombinant human erythropoetin in end-stage renal disease: The case for subcutaneous administration. J Am Soc Nephrol 2(9):1405–1416PubMed

31.

Besarab A, Reyes CM, Hornberger J (2002) Meta-analysis of subcutaneous versus intravenous epoetin in maintenance treatment of anemia in hemodialysis patients. Am J Kidney Dis 40(3):439–446CrossRef

32.

Kaufman JS, Reda DJ, Fye CL et al (1998) Subcutaneous compared with intravenous epoetin in patients receiving hemodialysis. Department of veterans affairs cooperative study group on erythropoetin in hemodialysis patients. N Engl J Med 339(9):578–583CrossRef

33.

Cody J, Daly C, Campbell M et al (2005) Frequency of administration of recombinant human erythropoetin for anaemia of end-stage renal disease in dialysis patients. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003895.pub2 CrossRefPubMed

34.

Toto RD, Pichette V, Navarro J et al (2004) Darbepoetin α effectively treats anemia in patients with chronic kidney disease with de novo every-other-week administration. Am J Nephrol 24(4):453–460CrossRef

35.

Ling B, Walczyk M, Agarwal A et al (2005) Darbepoetin α administered once monthly maintains hemoglobin concentrations in patients with chronic kidney disease. Clin Nephrol 63(5):327–334CrossRef

36.

Brunkhorst R, Bommer J, Braun J, German Aranesp Study Group (2004) Darbepoetin α effectively maintains haemoglobin concentrations at extended dose intervals relative to intravenous or subcutaneous recombinant human erythropoetin in dialysis patients. Nephrol Dial Transplant 19(5):1224–1230CrossRef

37.

Jadoul M, Vanrenterghem Y, Foret M et al (2004) Darbepoetin α administered once monthly maintains haemoglobin levels in stable dialysis patients. Nephrol Dial Transplant 19(4):898–903CrossRef

38.

Charles RJ, Sabo KM, Kidd PG et al (1996) The pathophysiology of pure red cell aplasia: Implications for therapy. Blood 87:4831–4838PubMed

39.

Eckardt K‑U, Casadevall N (2003) Pure red cell aplasia due to anti-erythropoetin antibodies. Nephrol Dial Transplant 18:865–869CrossRef

40.

Maxwell PH, Eckardt KU (2016) HIF prolyl hydoylase inhibitors fort he treatment of renal anemia and beyond. Nat Rev Nephrol 12:157–168CrossRef

Titel: Renale Anämie
verfasst von: Dr. C. C. Haufe
Publikationsdatum: 04.07.2019
Verlag: Springer Medizin
Schlagwörter: Epoetin alfa
Chronische Nierenerkrankung
Anämien
Folsäure
Epoetin alfa
Epoetin alfa
Erschienen in: Die Nephrologie / Ausgabe 4/2019
Print ISSN: 2731-7463
Elektronische ISSN: 2731-7471
DOI: https://doi.org/10.1007/s11560-019-0356-5

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