Management der renalen Anämie – Epoetine und Eisen

Die Rahmenbedingungen der Epoetinbehandlung bei renaler Anämie haben sich innerhalb der letzten Jahre erheblich geändert. Vor allem die Ergebnisse der CREATE-, CHOIR- und TREAT-Studien bei CKD-Patienten haben dazu geführt, dass die Zulassungsbehörden und Fachgesellschaften den anzustrebenden Ziel-Hämoglobin-Wert auf einen Bereich von 11–12 g/dl reduziert haben. Von einer Vollkorrektur der Anämie wird ausdrücklich abgeraten. Die Zulassung von Biosimilars hat zu einem erheblichen Preisrückgang im Bereich der Epoetine (auch bei den Originatorpräparaten) geführt. Bei der Epoetintherapie soll zukünftig mehr Augenmerk auf die Konstanz der erreichten Hämoglobinkonzentrationen gerichtet werden, allzu große Wertschwankungen sollte man vermeiden. Ultrahohe Dosierungen bei Hyporespondern sollen nach Maßgabe der FDA nicht mehr zum Einsatz kommen: Die Epoetindosis ist in solchen Fällen gerade so hoch zu wählen, dass keine Bluttransfusionen notwendig sind.

The basic rules for epoetin treatment of renal anemia have changed considerably during the past few years. Especially the results of the CREATE, CHOIR and TREAT studies in CKD patients prompted the licensing authorities and medical societies to reduce the target range of the hemoglobin level to 11–12g/dl. They now definitely discourage a complete correction of anemia. Permitting the use of biosimilars resulted in a considerable price reduction of epoetins (including the original preparations). It is stipulated that future epoetin therapy should increasingly aim for stable hemoglobin concentration avoiding large variations. The FDA stresses the fact that ultra-high dosages should definitely not be administered to hyporesponders. In such cases, the epoetin dosage should be on a level just to avoid blood transfusions.

Key words

renal anemia - epoetin - dosage - iron - target hemoglobin level

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1 Third National Health and Nutrition Examination Survey

2 Correction of hemoglobin and outcomes in renal insufficiency

3 Cardiovascular risk reduction by early anemia treatment with epoetin beta

4 Trial to reduce cardiovascular events with aranesp therapy

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