促红素在CKD患者中的使用.ppt

2006 Kidney Disease: Improving Global Outcomes (KDIGO) position statement that was published 3 years ago (2 years before the results of the TREAT trial), according to the available evidence, suggested a target range between 9.5 and 11.5 g/dL while waiting for the results of TREAT. Dr. Singh is now suggesting a target of 9-12 g/dL for CKD patients not undergoing dialysis. ESA treatment should be individualized to patients and generally should aim to keep the hemoglobin between 9-12 g/dL. Francesco Locatelli : Dont Change the Hemoglobin Targets Francesco Locatelli : It is not the hemoglobin level per se (on the range suggested by guidelines) that could be dangerous, but the way we are correcting anemia in our patient population. 入组了1233例存在充血性心衰或缺血性心脏疾病的血液透析患者。 其中618例接受增加剂量的促红素治疗使Hct维持在0.42；615例也接受促红素治疗，但Hct维持在0.30。共治疗14个月。 主要终点：死亡或非致死性心肌梗死。 N Engl J Med ，1998 两组之间的平均Hct值和EPO的剂量从第一个月起即存在显著性差异（P0.001) Francesco Locatelli ： 为了避免风险，不应该过快地纠正贫血，而不是拒绝将其提高到正常水平。（I think the trial is very instructive in suggesting that we should not be too quick in correcting anemia, in order to avoid the risk for, for example, vascular thrombosis. Something to think about is that the patients who reached a hematocrit level of 42% (thus the normalization of their hemoglobin levels ) had the best survival ）had the best survival. Francesco Locatelli： TREAT、CHOIR和 CREATE 等几项临床研究的对照组的Hb水平都是在现在指南推荐的范围，所以这些研究都是将指南建议的Hb水平与更高水平的Hb水平相比。而得出的结论就是目前指南推荐的Hb水平比Hb纠正至正常水平更好。 在TREAT研究中，darbepoetin组的卒中发生率比对照组高，主要由于本组病人既往的卒中病史，而且卒中的风险主要可能与ESA相关。 在TREAT研究中，对照组的Hb水平从开始时的10.4g/dl上升至结束时的11.2g/dl，基本符合指南的推荐水平。所以不能推论从Hb9g/dl开始治疗。 我们缺少数据比较Hb在11-12g/dl之间与更高或更低的Hb水平。 Francesco Locatelli： To maintain the safe hemoglobin target of 11 and 12 g/dL, but at the same time we need to take into consideration the patient characteristics, and the amount of iron and ESA for reaching this target. Dr. Singh： ESAs：disease modifying symptom modifying The trials have now demonstrated almost u