Benefits and risks of erythrocyte-stimulating agents

摘要

Chronic kidney disease(CKD)is a common and serious clinical problem.Anemia in patients with advanced CKD,frequently called renal anemia,causes disabling fatigue and diminishes patients’quality of life.Frequent and excess transfusions or iron supplementation are potentially hazardous.Although it remains unclear whether the main factor in the development of renal anemia is the failure of erythropoietin(EPO)production in the kidney or a dysfunction in oxygen sensing exogenous EPO administration is considered a rational treatment.The advent of recombinant human erythropoietin(rHu-EPO)products has dramatically changed the therapeutic strategy for renal anemia.Although rHu-EPO therapy has improved patients’quality of life and decreased the need for blood transfusions,some potential adverse effects have been reported till date.This brief review discusses the treatment of renal anemia with regard to the following:(1)historical background;(2)effectiveness of rHu-EPO;(3)some topics regarding the treatment of anemia,including EPO resistance,hemoglobin(Hb)cycling,and adequate Hb levels;(4)major adverse effects of rHu-EPO,including hypertension,thrombotic complications,and pure red cell aplasia;and(5)future problems to be resolved.