Erythropoetin – Differenzierter Einsatz unter Einbeziehung der neuen Leitlinien

Zusammenfassung

Die optimale Therapie der Anämie bei chronischen Nierenerkrankungen (CKD) wird derzeit an die neuesten Studienergebnisse angepasst. Insbesondere die TREAT-Studie hat in den neuen internationalen Leitlinien dazu geführt, dass die Zielwerte der Therapie hinsichtlich des Hämoglobins (Hb) deutlich nach unten adjustiert wurden. Für Dialysepatienten wird jetzt ein Zielkorridor von 9–10 g % Hb angegeben. Allerdings verweisen die Leitlinien auch auf die Notwendigkeit zur Individualisierung der Therapie. Zudem spielt insbesondere bei jungen Patienten auch der Aspekt der Leistungsfähigkeit und der Lebensqualität, die mit höheren Hb-Werten verbunden ist, eine große Rolle. Daraus folgt, dass wie in anderen Bereichen der modernen Medizin eine individuelle Therapie das Ziel sein muss. Um jedoch für die zunehmende Population älterer Patienten mit CKD die negativen Folgen einer zu hohen Korrektur der renalen Anämie zu vermeiden, sind die Angaben in der neuen KDIGO-Leitlinie sinnvoll und anwendbar.

Summary

The goals of anemia therapy in patients with chronic kidney disease (CKD) are adjusted due to the results of new studies. Especially the TREAT study had major influence for the new international guidelines and the goals of therapy are now adjusted downwards regarding the results of the studies. The goal of anemia therapy for patients on dialysis are now hemoglobin values of 9–10 g %. However, in the new guidelines the need for an individualization of therapy is highlighted, especially in young patients. For young patients, the aspects of performance and life quality have major importance and these are fixed to higher hemoglobin values. Following that, we have to state that also in this part of modern medicine an individualization of therapy is warranted. However, for the growing proportion of elderly patients with CKD, the new guidelines point to the problems connected to normalization of hemoglobin and therefore, the new KDIGO guidelines help to avoid these critical situations.

Key words

chronic kidney disease - anemia - ESA - erythropoietin - guideline

• Literatur

• 1 Stevens LA, Coresh J, Greene T et al. Assessing kidney function-measured and estimated glomerular filtration rate. N Engl J Med 2006; 354: 2473-2483
• 2 Babitt JL, Lin HY. Mechanisms of anemia in CKD. J Am Soc Nephrol 2012; 23: 1631-1634
• 3 KDIGO. KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Int Suppl 2012; 2: 279-335
• 4 Parfrey PS, Lauve M, Latremouille-Viau D et al. Erythropoietin therapy and left ventricular mass index in CKD and ESRD patients: a meta-analysis. Clin J Am Soc Nephrol 2009; 4: 755-762
• 5 Besarab A, Bolton WK, Browne JK et al. 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 1998; 339: 584-590
• 6 Locatelli F, Del Vecchio L, Pozzoni P. Anemia and cardiovascular risk: the lesson of the CREATE Trial. J Am Soc Nephrol 2006; 17: S262-S266
• 7 Pfeffer MA, Burdmann EA, Chen CY et al. A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med 2009; 361: 2019-2032
• 8 Abramson JL, Jurkovitz CT, Vaccarino V et al. Chronic kidney disease, anemia, and incident stroke in a middle-aged, community-based population: the ARIC Study. Kidney Int 2003; 64: 610-615
• 9 Skali H, Parving HH, Parfrey PS et al. Stroke in patients with type 2 diabetes mellitus, chronic kidney disease, and anemia treated with Darbepoetin Alfa: the trial to reduce cardiovascular events with Aranesp therapy (TREAT) experience. Circulation 2011; 124: 2903-2908
• 10 Winkelmayer WC. What caused excess strokes in patients randomized to darbepoetin in the trial to reduce cardiovascular events with Aranesp therapy (TREAT)?: no smoking gun. Circulation 2011; 124: 2805-2808
• 11 Lawler EV, Bradbury BD, Fonda JR et al. Transfusion burden among patients with chronic kidney disease and anemia. Clin J Am Soc Nephrol 2010; 5: 667-672
• 12 Leaf DE, Goldfarb DS. Interpretation and review of health-related quality of life data in CKD patients receiving treatment for anemia. Kidney Int 2009; 75: 15-24
• 13 Choukroun G, Kamar N, Dussol B et al. Correction of postkidney transplant anemia reduces progression of allograft nephropathy. J Am Soc Nephrol 2012; 23: 360-368
• 14 Eckardt KU, Scherhag A, Macdougall IC et al. Left ventricular geometry predicts cardiovascular outcomes associated with anemia correction in CKD. J Am Soc Nephrol 2009; 20: 2651-2660
• 15 Drueke TB, Parfrey PS. Summary of the KDIGO guideline on anemia and comment: reading between the (guide)line(s). Kidney Int 2012; 82: 952-960
• 16 Van Wyck DB. Management of early renal anaemia: diagnostic work-up, iron therapy, epoetin therapy. Nephrol Dial Transplant 2000; 15 (Suppl. 3): 36-39