Burden Of Anemia nyob rau hauv Kab Mob Raum Ntev: Tshaj Erythropoietin

Hu rau: Audrey Hu Whatsapp / hp: 0086 13880143964 Email:audrey.hu@wecistanche.com

Ramy M. Hanna. Elani Streja: koj puas xav tau ntau tus thwjtim? Kamyar Kalantar-Zadeh

TSAB NTAWV

Anemia yog ib qho mob hnyav heevmob ntevraum kab mob(CKD) thiab muaj feem cuam tshuam nrog lub nra hnyav vim tias tus neeg mob txo qis txog kev noj qab haus huv ntawm lub neej thiab kev siv cov khoom siv kho mob ntau ntxiv. Raws li cov ntaub ntawv soj ntsuam, anemia yog txuam nrog kev pheej hmoo siab ntawmCKDkev loj hlob, kab mob plawv, thiab tag nrho-ua rau kev tuag. Cov txheej txheem tam sim no ntawm kev saib xyuas suav nrog qhov ncauj lossis tso cov hlau ntxiv, cov tshuaj erythropoiesis-stimulating agents, thiab ntshav liab. Txawm li cas los xij, txhua qhov kev kho mob no muaj nws tus kheej cov teeb meem ntawm cov neeg mob tshwj xeeb, suav nrog kev pheej hmoo ntawm cov kab mob plawv, thrombosis, thiab kev tuag. Cov neeg mob tau txais kev lim ntshav lossis cov neeg uas muaj ntshav qab zib ib txhij lossis ntshav siab tuaj yeem ua rau muaj kev pheej hmoo ntau dua ntawm kev tsim cov teeb meem no. Tshwj xeeb, kev kho mob nrog cov koob tshuaj ntau ntawm erythropoiesis-stimulating cov neeg ua haujlwm tau cuam tshuam nrog kev nce hauv tsev kho mob, cov xwm txheej hauv plawv, thiab kev tuag. Kev tawm tsam rau erythropoiesis-stimulating cov neeg ua haujlwm tseem yog ib qho kev sib tw kho mob hauv cov neeg mob. Hypoxia-inducible factor transcription factor, uas tswj ntau cov noob koom nrog hauv erythropoiesis thiab hlau metabolism, tuaj yeem ruaj khov los ntawm chav kawm tshiab ntawm cov tshuaj uas ua raws li inhibitors ntawm hypoxia-inducible factor prolyl-hydroxylase enzymes los txhawb erythropoiesis thiab nce qib hemoglobin. Ntawm no, peb tshuaj xyuas lub nra ntawm anemia ntawmmob ntevraumkab mob, qhov tsis txaus ntawm cov qauv kev saib xyuas tam sim no, thiab cov txiaj ntsig zoo ntawm hypoxia-inducible factor prolyl-hydroxylase inhibitors hauv kev kho mob ntawm cov neeg mob ntshav qab zib.CKD.

Ntsiab lus:Ntshav Qab Zib; Burden;Ntevraumkab mob; Erythropoietin; Hypoxia-inducible yam; Hlau; Nephrology

Cistanche deserticola tiv thaivraumkab mob, nyem qhov no kom tau txais cov qauv

Hemoglobin (Hb)\13.raumthiab/los yog hloov pauv hlau homeostasis [4, 5]. Cov txheej txheem tam sim no ntawm kev saib xyuas cov ntshav ntshav ntawm CKD suav nrog qhov ncauj lossis qhov tso quav (IV) hlau, erythropoiesis-stimulating agents (ESAs), thiab ntshav liab (RBC), txhua tus muaj teeb meem muaj peev xwm thiab muaj txiaj ntsig sib txawv [2, 3]. Qhov cuam tshuam ntawm kev kho ntshav qab zib rau cov neeg mob kev noj qab haus huv ntsig txog lub neej zoo (HR-QOL) tsis paub, thiab cov teeb meem kev nyab xeeb tsis tu ncua ua rau muaj kev tsis paub meej txog lub hom phiaj zoo Hb. Kab lus no tshuaj xyuas lub nra ntawm ntshav qab zib ntawm CKD, suav nrog nws qhov cuam tshuam rau kev tuag thiab kev pheej hmoo plawv, HR-QOL, kev xav tau pw hauv tsev kho mob thiab hloov pauv, kev xav tau ntawm cov hlau ntxiv, kev tswj hwm kev saib xyuas ntawm CKD kom ncua kev lim ntshav, kev hloov pauv hauv lub raum kawg (ESRD) Cov txiaj ntsig, kev tswj ntshav qab zib hauv tsev, thiab kev tswj ntshav qab zib hauv cov neeg tau txais kev hloov pauv. Kev ntsuam xyuas ntawm qhov pheej hmoo rau cov txiaj ntsig profile cuam tshuam nrog cov qauv kev saib xyuas tam sim no thiab kev sib tham nyob ib puag ncig cov neeg ua haujlwm tshiab hauv kev txhim kho raws li lwm txoj hauv kev erythropoietic mechanisms kuj tau muab. Kab lus no yog ua raws li kev tshawb fawb yav dhau los thiab tsis muaj cov kev tshawb fawb nrog tib neeg cov neeg koom lossis cov tsiaj ua los ntawm ib tus kws sau ntawv.

DIGITAL NTA

Tsab ntawv xov xwm no tau luam tawm nrog cov yam ntxwv digital, suav nrog cov ntsiab lus swb, txhawm rau kom nkag siab txog kab lus. Txhawm rau saib cov yam ntxwv digital rau kab lus no mus rau https://doi.org/10.6084/ m9.fifigshare.13035146.

Taw qhia

Anemia yog ib qho teeb meem ntawmmob ntevraumkab mob(CKD), sawv cev rau lub nra hnyav rau cov neeg mob thiab cov kab ke kho mob [1, 2]. Raws li covLub raumKab mob: Txhim kho Cov txiaj ntsig thoob ntiaj teb (KDIGO) cov txheej txheem kev kho mob, ntshav ntshav ntawm CKD txhais tau tias yog hemoglobin (Hb)\13.0 g/dl rau txiv neej thiab\12.0 g/dl rau cov poj niam tsis cev xeeb tub [3] thiab feem ntau tshwm sim los ntawm kev txo qis erythropoietin (EPO) ntau lawm los ntawm kev ua tsis tiavraumthiab/los yog hloov pauv hlau homeostasis [4, 5]. Cov txheej txheem tam sim no ntawm kev saib xyuas cov ntshav ntshav ntawm CKD suav nrog qhov ncauj lossis qhov tso quav (IV) hlau, erythropoiesis-stimulating agents (ESAs), thiab ntshav liab (RBC), txhua tus muaj teeb meem muaj peev xwm thiab muaj txiaj ntsig sib txawv [2, 3]. Qhov cuam tshuam ntawm kev kho ntshav qab zib rau cov neeg mob kev noj qab haus huv ntsig txog lub neej zoo (HR-QOL) tsis paub, thiab cov teeb meem kev nyab xeeb tsis tu ncua ua rau muaj kev tsis paub meej txog lub hom phiaj zoo Hb. Kab lus no tshuaj xyuas lub nra ntawm anemia ntawm CKD, suav nrog nws qhov cuam tshuam rau kev tuag thiab kev pheej hmoo plawv, HR-QOL, kev xav tau hauv tsev kho mob thiab kev hloov pauv, kev xav tau ntawm cov hlau ntxiv, kev tswj hwm kev saib xyuas ntawmCKDtxhawm rau ncua kev lim ntshav, qhov kawg ntawm lub raum kab mob (ESRD) hloov pauv cov txiaj ntsig, kev tswj ntshav qab zib hauv tsev, thiab kev tswj ntshav qab zib hauv cov neeg tau txais kev hloov pauv. Kev ntsuam xyuas ntawm qhov pheej hmoo rau cov txiaj ntsig profile cuam tshuam nrog cov qauv kev saib xyuas tam sim no thiab kev sib tham nyob ib puag ncig cov neeg ua haujlwm tshiab hauv kev txhim kho raws li lwm txoj hauv kev erythropoietic mechanisms kuj tau muab. Kab lus no yog ua raws li kev tshawb fawb yav dhau los thiab tsis muaj cov kev tshawb fawb nrog tib neeg cov neeg koom lossis cov tsiaj ua los ntawm ib tus kws sau ntawv.

Cov teebmeem ntawm cistanche: kho cov kab mob raum

KEV PAB CUAM

Prevalence Qhov kwv yees thoob ntiaj teb kev sib kis ntawm CKD yog 11 feem pua ​​​​rau cov neeg mob CKD theem 3 [kwv yees glomerular fifiltration rate (eGFR)\ 60 ml/min/ 1.73 m2] mus rau theem 5 (eGFR \ 15 ml / min / 1.73 m2) thiab 13 feem pua ​​​​rau cov neeg mob nrog CKD theem 1 (albumin-rau-creatine piv [30 ntxiv rau eGFR [90 ml / min / 1.73 m2) rau theem 5 [6]. Hauv Teb Chaws Asmeskas, qhov tshwm sim ntawm theem 1-5 CKD yog 14.0 feem pua ​​(repre xa * 31.4 lab tus tib neeg) raws li 2007-2010 cov ntaub ntawv los ntawm National Health and Nutrition Examination Survey (NHANES) [7]. Ib yam li ntawd, Tebchaws Asmeskas Lub Chaw Tiv Thaiv thiab Tiv Thaiv Kab Mob tau kwv yees tias qhov muaj ntau ntawm CKD theem 1 txog theem 4 (eGFR 15–29 ml / min / 1.73 m2 ) yog 15 feem pua ​​(* 37 lab tus tib neeg) hauv 2013-2016 [8].

Anemia prevalence nce nrog rau theem CKD. Hauv kev tshuaj xyuas NHANES, 15.4 feem pua ​​(* 4.8 lab tus tib neeg) muaj ntshav qab zib CKD, thiab ntshav qab zib ntau yog 17.4 feem pua, 50.3 feem pua, thiab 53.4 feem pua ​​​​hauv theem 3, 4, thiab 5 CKD, raws li [ 7]. Anemia ntawm CKD feem ntau kuj nce ntxiv rau cov neeg mob uas muaj kev tsis sib haum xeeb thiab muaj hnub nyoog, los ntawm 28.0 feem pua ​​​​ntawm cov hnub nyoog 18-63 xyoo mus rau 50.1 feem pua ​​​​ntawm cov neeg muaj hnub nyoog C 66 xyoo ntawm Asmeskas cov neeg mob uas tsis yog kev lim ntshav-dependent (NDD) CKD [1].

Cardiovascular Risk thiab Mortality

Anemia, kua dej ntau dhau, thiab arteriovenous fistulas tuaj yeem ua rau qhov ntim ntau dhau uas thaum kawg ua rau cardiomyopathy, suav nrog nce ventricular hypertrophy (LVH), thiab systolic thiab diastolic dysfunction [9, 10]. Qhov no cardiomyopathy tuaj yeem tshwm sim raws li kab mob ischemic plawv lossis lub plawv tsis ua haujlwm, txawm tias thaum tsis muaj kab mob vascular arterial [10]. Anemia tau cuam tshuam nrog kev pheej hmoo siab ntawm cov kab mob plawv thiab tag nrho cov neeg tuag nyob rau hauv ntau cov kev tshawb fawb soj ntsuam [11–18], thiab American Heart Association suav tias yog ntshav qab zib yog ib qho tsis zoo (tsis yog-Framingham) cov kab mob plawv hauv cov neeg mob. CKD [10]. Hauv Asmeskas txoj kev tshawb fawb ntawm [900,000 cov neeg mob uas muaj NDD-CKD, kev ua haujlwm tsis muaj hlau tsis txaus ntshav ntshav tau cuam tshuam nrog kev pheej hmoo ntawm kev tuag [kev phom sij (HR) 1.11, 95 feem pua ​​​​CI 1.07–1.14] thiab cov txheeb ze nce ntxiv kev pheej hmoo (RR) ntawm kev mob plawv hauv tsev kho mob tom qab 1 xyoos (RR 1.21, 95 feem pua ​​CI 1.12–1.30) thiab 2 xyoos (RR 1.13, 95 feem pua ​​CI 1.07–1.21) [11]. Ib yam li ntawd, ib txoj kev tshawb fawb Danish ntawm cov neeg mob ntshav qab zib-CKD (DD CKD) thiab NDD-CKD pom tias ntshav ntshav tau cuam tshuam nrog kev pheej hmoo ntawm cov teeb meem plawv plawv loj (MACE), mob rau hauv tsev kho mob, thiab txhua yam ua rau tuag [12], thiab kev tshawb fawb Nyij Pooj ntawm NDD-CKD cov neeg mob tau tshaj tawm tias cov kab mob sib cais thiab cov hlau tsis muaj hlau tsis txaus muaj feem cuam tshuam nrog kev pheej hmoo ntawm cov hlab plawv thiab tag nrho cov neeg tuag [13]. Tom qab hloov kho rau lwm yam kab mob plawv (xws li hnub nyoog, ntshav qab zib, ntshav siab, thiab dyslipidemia), cov neeg mob ntshav qab zib hauv Teb Chaws Asmeskas Atherosclerosis Risk hauv Cov Zej Zog (ARIC) txoj kev tshawb fawb tau muaj kev pheej hmoo siab mob stroke nrog comorbid CKD piv tsis muaj CKD (HR 5.43, 95 feem pua ​​CI 2.04–14.41), whereas hauv cov neeg mob uas tsis muaj ntshav liab, qhov kev pheej hmoo ntawm mob stroke nrog CKD tsis tau nce ntxiv (HR 1.41, 95 feem pua ​​​​CI 0.93–2.14) [14]. Hauv cov neeg mob ntshav qab zib mellitus, kev txheeb xyuas cov ntaub ntawv los ntawm ARIC, Cardiovascular Health, Framingham Heart, thiab Framingham Offspring cov kev tshawb fawb pom muaj kev sib koom ua ke ntawm cov ntshav qab zib thiab muaj kev pheej hmoo ntawm tus kheej thiab cov txiaj ntsig sib xyaw ntawm myocardial infarction (MI), kab mob plawv tuag, mob stroke, lossis tuag, thiab tag nrho-ua rau kev tuag ntawm cov neeg mob comorbid CKD, tab sis tsis yog nyob rau hauv cov tsis muaj CKD [15]. Ib qho kev sib koom ua ke ntawm qib Hb qis thiab muaj kev pheej hmoo ntau ntxiv ntawm cov hlab plawv thiab kev tuag tag nrho kuj tau pom nyob rau hauv kev tshawb fawb Kauslim ntawm *300,000 cov neeg mob uas tsis muaj kab mob plawv [16]. Tsis tas li ntawd, anemia tau cuam tshuam nrog kev pheej hmoo siab plawv ntawm cov neeg Nyij Pooj uas tau kho mob ntshav siab [17] thiab hauv kev tshawb fawb Italian ntawm cov neeg mob ntshav qab zib [18].

Txawm li cas los xij, kev koom tes ntawm kev mob ntshav qab zib thiab mob plawv thiab kev tuag hauv cov neeg mob nrog CKD feem ntau yog los ntawm kev soj ntsuam kev tshawb fawb, thiab kev sim randomized tseem tsis tau pom tias txo qis kev pheej hmoo tuag nrog kev kho mob ntshav qab zib [19]. Qhov tseem ceeb, kev sim tshuaj ntsuam xyuas uas tau sim nce Hb mus rau qib siab (13–13.5 g / dl) nrog darbepoetin alfa txoj kev kho pom tau tias muaj kev pheej hmoo ntawm kev tuag los yog mob plawv- lossis mob raum mob raum piv nrog lub hom phiaj ze li qub lossis qis Hb (11.3). g/dl; HR 1.34, 95 feem pua ​​​​CI 1.03–1.74, P=0.03) [20] thiab tseem muaj kev pheej hmoo ntawm kev tuag lossis tsis tuag stroke piv nrog cov placebo (HR 1.92, 95% CI 1.38–2.68, P \ 0.001) [21].

Cov teebmeem ntawm cistanche: khomob plawvkab mob

Health-Related Quality of Life

Anemia ntawm CKD sawv cev rau qhov muaj kev pheej hmoo ywj pheej rau cov neeg pluag HR-QOL [22]. Hauv cov neeg mob uas muaj CKD anemia, cov teeb meem ntawm lub plawv muaj feem cuam tshuam nrog kev ua haujlwm tsis zoo HR-QOL (EQ-5D pom cov duab analog scale coefficient -5.68, P=0.028) thiab kev ua haujlwm ua haujlwm Productivity thiab Activity Impairment questionnaire: activim impairment coefficient 8.04, P=0.032) piv nrog cov neeg mob uas tsis yog-anemic CKD [23]. Lub Chaw Pabcuam Medicare thiab Medicaid tau hais tias txhua chav lim ntshav yuav tsum nquag saib xyuas tus neeg mob HR-QOL, qhia txog qhov xav tau kom nkag siab txog qhov cuam tshuam ntev HR-QOL thaum kho cov ntshav ntshav thiab lwm yam mob hauv cov neeg mob CKD [24].

Kev siv nyiaj txiag kho mob

Kev mob ntshav siab ntau ntawm CKD yog ib qho tseem ceeb hauv kev kho mob thiab kev noj qab haus huv [25]. Cov neeg mob uas muaj CKD nruab nrab thiab ntshav ntshav hnyav (Hb B 9 g / dl) feem ntau yuav tsum tau pw hauv tsev kho mob ntau dua piv nrog cov tsis muaj ntshav qab zib hnyav [26]. Vim tias cov neeg mob CKD thiab ntshav ntshav siv ntau qhov kev kho mob tag nrho, lawv cov kev saib xyuas raug nqi ntau dua li cov tsis muaj ntshav qab zib [1]. Hauv Teb Chaws Asmeskas, cov neeg mob ntshav qab zib CKD tau kwv yees tag nrho cov nqi kho mob ntawm US $ 3800-US $ 4800 / tus neeg mob-hli [27]; Cov nqi kho mob txhua xyoo ntawm Asmeskas cov neeg mob nrog CKD tau kwv yees ntau dua peb npaug ntawm cov neeg mob ntshav qab zib ntau dua li cov tsis muaj ntshav qab zib [28].

TSAM TSEEM CEEB NTAWM CARE

Cov kev xaiv kho mob tam sim no rau ntshav ntshav muaj xws li qhov ncauj lossis IV hlau, ESAs, thiab RBC hloov pauv (Table 1). Txawm hais tias kev nce qib Hb tuaj yeem ua rau muaj kev txhim kho HR-QOL, morbidity, tuag, thiab txo kev mus pw hauv tsev kho mob [29, 30], nce Hb mus rau 'ib txwm' qib tau ua rau cov txiaj ntsig tsis zoo qhia txog cov teeb meem cuam tshuam nrog cov qauv kev saib xyuas tam sim no. anemia ntawm CKD.

Cov teebmeem ntawm cistanche: khontshav qab zibkab mob

Hlau

Hlau deficiency feem ntau tshwm sim nyob rau hauv cov neeg mob nrog CKD thiab yog kho los ntawm hepcidin, ib tug hepatic peptide uas inhibits hlau nqus thiab tso tawm los ntawm cov khw muag khoom hlau thiab macrophages [5]. Iron deficiency yog compounded los ntawm kev xav tau hlau ntxiv nrog ESAs, uas tuaj yeem txwv lawv cov txiaj ntsig [39]. Cov hlau ntxiv tuaj yeem txhim kho lub cev, kev txawj ntse, thiab kev tiv thaiv kab mob [40]. Txawm hais tias tsis tshua kim thiab muaj kev nyab xeeb dua li IV hlau, qhov ncauj hlau tsis zoo absorbed thiab cuam tshuam nrog kev mob plab hnyuv [3]. IV hlau tso cai rau kev tswj hwm ntawm cov koob tshuaj loj dua nrog kev ua kom zoo dua qub thiab suav tias yog qhov zoo tshaj rau qhov ncauj hlau hauv cov neeg mob CKD [41].

Txawm hais tias tsis tshua muaj, IV kev tswj hwm hlau tuaj yeem cuam tshuam nrog kev pheej hmoo ntawm cov hlau ntau dhau, uas tuaj yeem ua rau lub cev tsis ua haujlwm hauv cov neeg mob uas muaj lossis tsis muaj ESRD, txawm hais tias qhov kawg ntawm lub cev puas tsuaj vim IV hlau tsis tau pom nyob rau hauv kev tshawb fawb soj ntsuam [42] . Hlau overload tuaj yeem ua rau muaj kev pheej hmoo kis kab mob thiab ua rau CKD cuam tshuam nrog o, thaum qhov mob tuaj yeem ua rau muaj kev ntxhov siab oxidative los ntawm IV hlau [42, 43]. Cov ntaub ntawv dhau los ntawm kev kub siab nrog IV hlau tau loj heev thaum siv cov hlau hnyav molecular-yuag dextrans uas tsis muaj kev lag luam ntxiv lawm [44, 45]. IV hlau yog lub nra hnyav rau cov neeg mob NDD-CKD vim tias xav tau kev nkag mus rau IV thiab chaw kho mob ntshav [46].

Erythropoiesis-Stimulating Agents ESAs ua rau EPO ntau lawm kom nce Hb thiab txhim kho ntshav qab zib [3]. Txawm hais tias ESAs txo qhov cuam tshuam tsis zoo ntawm ntshav qab zib rau kev mob ntshav qab zib thiab HR QOL [47], kev txhawj xeeb txog kev nyab xeeb txog kev pheej hmoo ntawm cov kab mob plawv nrog cov koob tshuaj ESA ntau ntxiv (vim cov lus teb tsis zoo lossis siab dua Hb lub hom phiaj) tau ua rau txo qis hauv ESA. koob tshuaj, nce kev siv RBC hloov pauv / IV hlau, thiab tsis paub meej txog kev pom zoo Hb [4]. Yog li ntawd, cov thawj coj tswj hwm xav tau cov ntaub ntawv ntxaws ntxaws txog kev nyab xeeb rau ESAs. Lwm qhov kev txiav txim siab rau kev siv ESA suav nrog kev tswj xyuas parenteral, kev cia txias, kev siv nyiaj, thiab kev tsim cov tshuaj tiv thaiv EPO antibodies, uas yuav ua rau muaj ntshav liab aplasia [4].

Kev cuam tshuam ntawm ESA-Mediated Anemia

Kev kho

Hemoglobin normalization nyob rau hauv cov neeg mob nrog CKD tam sim no tsis pom zoo vim muaj kev txhawj xeeb txog kev nyab xeeb ntsig txog ESA ntau npaum [48]. Qee cov kev tshawb fawb qhia txog cov txiaj ntsig ntawm cov hlab plawv hauv kev kho mob qis Hb lub hom phiaj thaum lwm tus piav qhia txog cov txiaj ntsig ntawm cov hlab plawv tsis zoo nrog lub hom phiaj ntawm lub cev los yog supraphysiologic Hb lub hom phiaj, ua rau lub hom phiaj zoo Hb tsis meej [3, 4, 30]. Cov koob tshuaj ESA siab dua (ntau dua Hb) yuav ua rau muaj kev cuam tshuam tsis zoo, vim tias cov neeg mob ESRD uas tswj Hb siab ([12 g / dl) tsis muaj ESA kho tsis pom kev tuag ntau dua piv nrog rau lwm cov neeg mob ntawm kev lim ntshav [49]. Cov lus qhia tam sim no pom zoo rau lub hom phiaj Hb B 11.5 g / dl [3].

Kev kho mob ntshav qab zib nrog ESAs tuaj yeem muab kev txhim kho hauv cov hlab plawv, suav nrog kev tshem tawm cov seem, sab laug ventricular (LV) qhov ntsuas qhov hnyav, thiab LV phab ntsa thickness [22, 50]. Hauv cov neeg mob uas muaj NDD-CKD, qhov kev pheej hmoo ntawm lub raum cov xwm txheej (piv txwv li, kev nce mus rau lub raum hloov kho, ob npaug ntawm cov ntshav creatinine, lossis poob hauv eGFR mus rau \ 6 ml / min / 1.73m2 ) tau qis dua rau cov neeg uas muaj Hb lub hom phiaj ntawm C. 11 g/dl versus \11 g/dl [51]. Txawm li cas los xij, ACORD, CHOIR, thiab CREATE cov kev tshawb fawb hauv cov neeg mob NDD-CKD tsis pom qhov zoo dua nrog qhov siab (13.0–15.0 g / dl) piv rau qis (10.5–11.5 g / dl) Hb lub hom phiaj hauv Kev pheej hmoo rau LVH [52] lossis cov xwm txheej hauv plawv (xws li kev tuag sai sai, mob stroke, ntu ntu ischemic nres, MI, mob plawv tsis ua haujlwm, mus pw hauv tsev kho mob rau angina pectoris, plawv arrhythmia, lossis congestive plawv tsis ua haujlwm, lossis teeb meem ntawm peripheral vascular kab mob) [20, 53 ]. Tsis tas li ntawd, hauv subanalysis ntawm TREAT sim, cov lus teb tsis zoo rau ESA kev kho mob (thiab yog li ntawd ntau dua ntawm ESA) hauv cov neeg mob NDD-CKD thiab hom 2 mob ntshav qab zib tau cuam tshuam nrog kev pheej hmoo ntawm kev tuag tag nrho (HR 1.41, 95. feem pua ​​CI 1.12–1.78) thiab cov xwm txheej tsis zoo ntawm cov hlab plawv (HR 1.31, 95 feem pua ​​CI 1.09–1.59) piv rau cov neeg mob uas muaj cov lus teb zoo dua rau ESA [54]. Vim tias muaj kev pheej hmoo ntau dua rau kev tuag, MACE, thiab mob hlab ntsha tawg nrog lub hom phiaj Hb C 13 g / dl [20, 21], US Food and Drug Administration (FDA) pom zoo tias ESA koob tshuaj yog tus kheej rau cov koob tshuaj qis tshaj plaws uas tsim nyog los txo qis RBC cov kev cai hloov ntshav. es tsis yog rau lub hom phiaj tshwj xeeb Hb [48]. Qhov tseem ceeb, tom qab FDA kev sib txuas lus, muaj 59 feem pua ​​-74 feem pua ​​​​txo qis hauv kev sau tshuaj ESAs txawm tias muaj cov kab mob ntshav qab zib ruaj khov [55]. Txawm li cas los xij, tsis muaj qhov txo qis hauv tus nqi ntawm kev tuag lossis MACE [56].

Kev cuam tshuam ntawm ESAs ntawm HR-QOL

Txawm hais tias cov txiaj ntsig tau tshaj tawm feem ntau, kev txhim kho tseem ceeb hauv HR-QOL tom qab ESA kev kho mob ntshav qab zib hauv cov neeg mob CKD tsis sib haum. ESA txoj kev kho tau cuam tshuam nrog kev txhim kho tseem ceeb hauv kev qaug zog, kev loj hlob, kev noj qab haus huv ntawm lub hlwb / kev xav zoo, thiab kev noj qab haus huv tag nrho ntawm cov neeg mob NDD-CKD [20]. Kho cov ntshav qab zib rau lub hom phiaj Hb ntawm 13-15 g / dl txhim kho HR-QOL hauv cov neeg mob CKD nrog lossis tsis muaj ntshav qab zib [52, 53] nrog kev txhim kho hauv ntau qhov subscales ntawm Short Form 36 kev soj ntsuam kev noj qab haus huv piv rau lub hom phiaj Hb ntawm 10.5– 11.5 g / dl [53]. Hauv qhov sib piv, ib qho kev ntsuam xyuas meta tau pom tias ESA txoj kev kho kom tau txais Hb lub hom phiaj siab dua (10.2–13.6 g / dl) tsis txhim kho HR QOL [57]. Hauv cov neeg mob nrog CKD ntawm kev lim ntshav, ESA txoj kev kho yog txuam nrog zoo tag nrho HR QOL thiab cov nqi qis dua thiab kev siv kev kho mob piv nrog tsis muaj ESA kho, txawm hais tias zoo li muaj txiaj ntsig tsawg nrog Hb lub hom phiaj siab dua [58]. Kev kho ib nrab ntawm anemia nrog ESAs hauv cov neeg mob lim ntshav tau pom tias txo qis qaug zog thiab txhim kho kev ua haujlwm siab thiab kev noj qab haus huv, thaum noj tshuaj ESA siab tau cuam tshuam nrog kev pheej hmoo siab plawv uas cuam tshuam tsis zoo rau HR-QOL, yog li ua rau tsuas yog kev txhim kho tag nrho. [59, 60] ib. Ntshav Ntshav Ntshav Ntshav Ua ntej ESA muaj, nquag RBC hloov pauv yog thawj txoj hauv kev kho CKD anemia [47]. Tam sim no, * 20 feem pua ​​​​ntawm cov neeg mob uas muaj NDD-CKD tau txais RBC hloov pauv [61]; Txawm li cas los xij, ntshav ntim ntau dhau, hyperkalemia, hlau overload, kab mob hauv cov ntshav, ua npaws, lossis allosensitization yuav tshwm sim [3]. Muab lub nra cuam tshuam nrog RBC hloov pauv, cov kws kho mob yuav tsum xav txog lwm txoj kev kho mob ntshav qab zib hauv CKD [61]. Txawm li cas los xij, RBC kev hloov pauv tsuas yog ib qho kev xaiv muaj nyob hauv qee cov neeg mob uas ESAs tsis pom zoo, piv txwv li, cov neeg mob qog noj ntshav uas tsis yog kws khomob cuam tshuam nrog ntshav ntshav (tshwj tsis yog rau cov neeg mob xaiv nrog myelodysplastic syndrome) [62].

Cov teebmeem ntawm cistanche: txhim kho kev tiv thaiv

TXOJ CAI TSHIAB

Cov Neeg Laus

Qhov tshwm sim ntawm cov kab mob plawv nce ntxiv hauv cov neeg laus uas muaj ntshav qab zib CKD [1]. Tseeb tiag, CKD, anemia, thiab kev txwv tsis pub txav mus los yog qhov tseem ceeb ntawm cov cim qhia txog kev pheej hmoo tuag rau cov neeg laus [63]. Cov neeg mob laus nrog CKD muaj cov kab mob inflammatory ntau dua, kev noj zaub mov tsis zoo, thiab kev mob plawv, nrog rau cov qib hepcidin nce ntxiv [64], muaj peev xwm ua rau cov hlau tsis zoo thiab / lossis ESA kho. Tsis tas li ntawd, Hb txo qis nrog lub hnub nyoog vim tias txo qis erythropoiesis, yog li lub hom phiaj zoo Hb hauv cov neeg laus yuav qis dua [64].

Cov teebmeem ntawm cistanche: anti-aging

Mob ntshav qab zib

Hom 2 mob ntshav qab zib feem ntau ua rau muaj kev loj hlob ntawm CKD thiab kuj tseem tuaj yeem ua rau muaj kev pheej hmoo ntawm ntshav ntshav hauv CKD [65]. Mob ntshav qab zib mellitus yog ib qho mob hnyav heev los ntawm hyperglycemia thiab lwm yam kab mob inflammatory, nrog rau kev rog rog, arterial hypertension, thiab dyslipidemia; Qhov kev mob ntxiv no tau xav tias ua rau EPO tsis txaus rau cov neeg mob ntshav qab zib [66-68]. Kev tsis txaus ntawm EPO thiab hlau, nrog rau kev tsis txaus siab rau EPO, yog cov txheej txheem tseem ceeb rau kev txhim kho ntshav qab zib hauv cov neeg mob ntshav qab zib mellitus [69]. Hauv cov neeg mob ntshav qab zib, ntshav qab zib feem ntau hnyav dua, tshwm sim ntawm theem ua ntej ntawm CKD, thiab cuam tshuam nrog kev pheej hmoo ntau dua ntawm cov kab mob plawv [70]. Tsis tas li ntawd, cov teeb meem mob ntshav qab zib macrovascular tseem ua rau muaj kev txhim kho atherosclerosis [71], uas tuaj yeem cuam tshuam ntxiv rau kev tswj ntshav qab zib. Txawm li cas los xij, txawm tias muaj kev pheej hmoo ntau ntxiv ntawm qhov tshwm sim tsis zoo hauv cov neeg mob ntshav qab zib thiab ntshav qab zib, feem ntau muaj kev kho mob tsis txaus ntseeg txog kev pib siv IV hlau lossis ESA kho hauv cov neeg mob no [72]. Hauv cov neeg mob uas muaj ntshav qab zib comorbid, kev kho mob nrog ESA darbepoetin alfa tsis pom qhov txo qis ntawm kev pheej hmoo ntawm cov txiaj ntsig sib xyaw (kev tuag lossis mob plawv thiab tuag lossis mob raum) thiab muaj kev pheej hmoo ntawm mob stroke ntau dua piv rau cov placebo [21]. Hauv txoj kev tshawb no, cov neeg mob uas muaj cov lus teb tsis zoo rau kev kho ESA (uas tau txais ntau dua ESA koob tshuaj kom tau raws li Hb lub hom phiaj) tau muaj kev pheej hmoo ntawm kev tuag tag nrho (HR 1.41, 95 feem pua ​​​​CI 1.12–1.78) thiab mob plawv (HR 1.31, 95 feem pua ​​​​CI 1.09–1.59) dua li cov lus teb pib zoo dua [54]. Qhov no qhia tau hais tias qee cov neeg mob ntshav qab zib thiab ntshav qab zib tuaj yeem tau txais txiaj ntsig los ntawm lwm txoj kev kho mob, tshem tawm qhov xav tau ntawm ESA koob tshuaj nce ntxiv hauv cov neeg uas muaj cov lus teb tsis zoo rau ESA txoj kev kho.

End-Stage Renal Disease

Hauv cov neeg mob uas muaj theem 3 CKD, cov neeg mob ntshav qab zib tau nce sai dua mus rau theem 4 thiab 5 CKD [73]. Dialysis ua lub luag haujlwm tseem ceeb hauv kev tswj hwm ESRD, tab sis HR-QOL rau cov neeg mob DD-CKD tseem muaj kev txhawj xeeb, qhia txog qhov xav tau rau kev ntsuas tus neeg mob ntau dua [74]. Ntxiv nrog rau cov ntshav poob cuam tshuam nrog hemodialysis, cov teeb meem ntawm kev mob ntshav qab zib hnyav ua rau txo qis HR-QOL thiab nce kev vam khom ntawm RBC hloov pauv [75]. Hlau overload yog lwm qhov kev txhawj xeeb thiab tau pom hauv 84 feem pua ​​​​ntawm cov neeg mob DD-CKD kho nrog ESAs thiab IV hlau [76]. Zoo ib yam li cov neeg mob uas muaj NDD-CKD, qhov tshwm sim tsis zoo tshwm sim hauv cov neeg mob DD-CKD, nrog cov neeg tuag ntau dua thiab tsis muaj qhov sib txawv ntawm cov xwm txheej hauv plawv thaum epoetin tau siv los tsom mus rau qib siab dua piv rau qis hematocrit [77]. Qhov tseem ceeb, kev txo qis ntawm CKD kev nce qib tsis tau pom nrog ESA kho.

Cov teebmeem ntawm cistanche: txhim kho lub raum ua haujlwm

Lub raum Transplantation

Cov kab mob ntshav qab zib tau txo qis tom qab hloov lub raum, los ntawm 71 feem pua ​​​​ua ntej hloov mus rau 51 feem pua ​​​​ntawm 6 lub hlis thiab 37 feem pua ​​​​ntawm 2 xyoos tom qab hloov pauv. Txawm li cas los xij, post-transplant anemia tshwm sim [78]. Hauv cov neeg tau txais kev hloov hauv lub raum, qis Hb yog ib qho kev kwv yees rau kev rov qab mus rau kev lim ntshav, graft tsis ua haujlwm, hloov lub raum tom qab, txo qis LV huab hwm coj ntsuas, lossis tuag [78, 79]. Kev siv ESA rau lub hom phiaj siab Hb (12.5–13.5 g / dl) zoo li txo qis ntawm lub raum kev ua haujlwm piv nrog qis Hb (10.5–11.5 g / dl) tom qab 3 xyoos ntawm kev rov qab mus rau cov neeg tau txais kev hloov hauv lub raum [80]. Ntawm cov ntawv ceeb toom, cov neeg mob uas muaj ESA hyporesponsiveness ua ntej hloov lub raum tseem hyporesponsive tom qab hloov pauv [81], qhia txog kev xav tau kev kho tshiab los kho ntshav ntshav hauv cov neeg nyob hauv cov neeg no.

TXOJ CAI TSHIAB

Raws li cov kev txwv tsis pub dhau los ntawm tus qauv kev saib xyuas tam sim no, cov kev kho tshiab tau zoo thiab zam tau rau CKD anemia yog xav tau. Ib qho kev cog lus tshwj xeeb ntawm cov neeg ua haujlwm hauv kev loj hlob yog hypoxia-inducible factor-prolyl hydroxylase (HIF-PH) inhibitors.

HIF-PH inhibitors

Hypoxia-inducible factor (HIF) tswj cov noob qhia hauv kev teb rau hypoxia, suav nrog cov noob koom nrog hauv erythropoiesis thiab hlau metabolism, txhawb kev nqus hlau, thauj hlau, thiab heme synthesis (Fig. 1) [37]. Qhov tseem ceeb, ua haujlwm ntawm kev tshawb pom ntawm HIF thiab nws cov txheej txheem ntawm kev ua tau txais 2019 Nobel nqi zog hauv Physiology lossis Tshuaj. Nyob rau hauv cov xwm txheej normoxic, HIF-PH enzymes txhawb HIF degradation; Yog li, xaiv HIF stabilization nrog HIF-PH inhibitors yog ib txoj hauv kev tshiab rau kev kho mob ntshav qab zib CKD [36, 82]. Ob peb HIF-PH inhibitors tam sim no tab tom txhim kho (Table 2). HIF-PH inhibitors yog siv los ntawm qhov ncauj, thiab txo qis EPO qib tau raug cuam tshuam nrog cov qib supraphysiologic feem ntau tau txais kev kho ESA (Daim duab 2) [82]. Cov kev tshawb fawb tsiaj tau pom tias HIF-PH inhibitors txhawb nqa EPO kev qhia hauv lub raum thiab daim siab, nce qib Hb hauv cov qauv ntawm cov ntshav ntshav ntawm CKD, suav nrog 5/6th nephrectomized nas [83, 84]. HIF-PH inhibitors kuj tau pom tias yuav txo qis hepcidin, uas tuaj yeem tso cai rau cov neeg mob mus rau cov khw muag khoom hlau thiab txo cov kev xav tau ntawm cov hlau ntxiv. Tsis tas li ntawd, HIF stabilization yuav tsum ua kom lub plab zom mov hlau nqus los ntawm kev nthuav qhia ntau ntxiv ntawm divalent hlau thauj khoom -1 thiab duodenal cytochrome B [85].

Pom zoo HIF-PH Inhibitors

Roxadustat (FG-4592) yog thawj-hauv-chav HIF PH inhibitor pom zoo hauv Nyij Pooj rau kev kho mob ntshav qab zib hauv cov neeg mob DD-CKD [121] thiab hauv Suav teb rau cov neeg mob DD-CKD lossis NDD-CKD [ 122] ib. Daprodustat (GSK1278863) thiab vadadustat (AKB-6548) kuj tau pom zoo hauv Nyij Pooj rau kev kho mob ntshav qab zib hauv cov neeg mob DD-CKD lossis NDD-CKD [123, 124]. Tag nrho peb cov HIF-PH inhibitors ua tau zoo txhawb EPO ntau lawm hauv cov neeg mob ntshav qab zib CKD, muab cov koob tshuaj nce ntxiv hauv Hb thiab txo qis hauv qib hepcidin, thiab yog li txhim kho tag nrho cov peev txheej hlau-binding (TIBC) [35, 90–93, 96– 98, 103, 125–127] ib.

Hauv cov neeg mob NDD-CKD, roxadustat tau cuam tshuam nrog cov txiaj ntsig zoo tshaj plaws thiab / lossis cov txiaj ntsig Hb cov lus teb tseem ceeb thiab kev hloov pauv ntawm cov hauv paus piv nrog cov placebo hauv Suav daprodustat hauv DD-CKD cov neeg mob yog nasopharyngitis [103]. Rau vadadustat, cov no yog nasopharyngitis, raws plab, thiab cem quav hauv cov neeg mob NDD-CKD [126] thiab nasopharyngitis, cem quav, thiab shunt stenosis hauv cov neeg mob DD-CKD [127].

Cov txiaj ntsig ua ntej los ntawm kev txheeb xyuas kev nyab xeeb ntawm NDD-CKD lossis ruaj khov DD-CKD cov neeg mob ntshav qab zib qhia tau tias muaj kev pheej hmoo zoo sib xws lossis txo qis ntawm MACE thiab MACE ntxiv rau lub plawv tsis ua haujlwm lossis tsis ruaj khov angina yuav tsum tau pw hauv tsev kho mob (MACE?) nrog roxa plua plav ntawm cov placebo thiab epoetin alfa. , raws li [130]. Hauv qhov xwm txheej DD-CKD cov neeg mob ntshav qab zib, HRs rau MACE thiab MACE? yog 0.70 (95 feem pua ​​CI 0.51–{16}}.97, P=0.03) thiab 0.66 ( 95 feem pua ​​​​CI 0.5–0.89, P=0.005), feem, nrog roxa plua plav ntawm piv rau epoetin alfa [130]. Xav tau kev soj ntsuam ntxiv kom paub tseeb tias qhov kev tshawb pom kev nyab xeeb thawj zaug no.

HIF-PH Inhibitors hauv Kev Txhim Kho

Ob peb lwm HIF-PH inhibitors nyob rau hauv txoj kev loj hlob, nrog rau cov ntaub ntawv muaj nyob rau hauv solid-state (BAY 85-3934), enarodustat (JTZ-951), thiab desidustat (Zyan1) (Table 2). Cov kev tshawb fawb no qhia txog koob tshuaj Hb nce thiab kev saib xyuas ntawm Hb (hauv NDD-CKD) thiab kev saib xyuas Hb (hauv DD CKD) rau solid-state [109], enarodustat [111, 112], thiab desidustat [113]. Txawm li cas los xij, siab Hb lossis qhov nce nrawm tau ua rau muaj qhov tshwm sim siab ntawm kev txiav tawm ntxov los ntawm qee qhov kev tshawb fawb ntawm molidustat [109]. Hauv kev tshawb fawb txuas ntxiv mus ntev DIALOGUE 3 thiab DIALOGUE 5, Hb tau khaws cia hauv lub hom phiaj ntau (10–12 g / dl) txog li 36 lub hlis nrog Monistat, nrog rau cov txiaj ntsig zoo sib xws rau darbepoetin lossis epoetin [110]. Kev nce TIBC thiab / lossis txo qis hepcidin thiab / lossis ferritin tau pom nrog cov neeg ua haujlwm no, uas feem ntau tau txais txiaj ntsig zoo [109, 112, 113]. Tsis tas li ntawd, tsiaj

Cov kev tshawb fawb tau qhia tias qhov ntev ntev ntawm roxadustat tsis cuam tshuam nrog kev ua haujlwm ntawm oncogenic [131, 132]. Txawm li cas los xij, cov ntaub ntawv kho mob mus sij hawm ntev yuav tsum tau ua kom paub meej tias kev nyab xeeb ntawm HIF-PH inhibitors hais txog cov xwm txheej ntawm cov hlab plawv thiab carcinogenesis.

Muaj peev xwm rau kev kho mob siv HIF-PH

Inhibitors

HIF-PH inhibitors tuaj yeem nthuav qhia ntau qhov txiaj ntsig zoo rau cov neeg mob ntshav qab zib CKD. Ntxiv nrog rau lawv qhov ncauj ntawm kev tswj hwm, HIF-PH inhibitors tuaj yeem muab ze rau ntawm lub cev EPO ntau dua li cov theem siab sib cuam tshuam nrog kev kho ESA [87, 95]. Tshaj li erythropoiesis stimulation, HIF-PH inhibitors tuaj yeem txhim kho cov hlau homeostasis [133] thiab yog li txo cov neeg mob cov kev xav tau ntawm cov hlau ntxiv, yog li muaj peev xwm txo cov nqi thiab tshuaj noj. Txawm hais tias cov ntaub ntawv ntawm tus nqi-kev ua tau zoo ntawm HIF-PH inhibitors raug txwv, ib qho kev tshuaj ntsuam xyuas tau ua los ntsuas tus nqi-zoo ntawm roxadustat hauv Suav cov neeg mob nrog NDD-CKD tau lees paub tias rox adustat yog tus nqi zoo piv nrog cov placebo [134].

Cov ntaub ntawv pov thawj qhia tias HIF-PH inhibitors tuaj yeem ua tau zoo yam tsis muaj qhov ua rau mob ntxiv [88], uas tuaj yeem muaj txiaj ntsig zoo rau cov neeg mob o, cuam tshuam nrog ntshav qab zib thiab tsis mob ntshav qab zib raum nrog rau cov mob hnyav (xws li, cuam tshuam nrog kev kis kab mob). Txawm hais tias cov ntaub ntawv kho mob hauv cov neeg mob uas yog ESA hyporesponsive tsawg, cov kev tshawb fawb tseem ceeb suav nrog cov neeg mob uas muaj mob me me, uas cuam tshuam nrog kev txo qis hauv kev kho ESA [135]. Hauv Suav theem, 3 txoj kev tshawb fawb ntawm roxadustat hauv cov neeg mob DD-CKD, kev nce qib Hb zoo sib xws tau pom hauv cov neeg mob uas muaj C-reactive protein ntau (B 4 thiab [4 mg / l) [35]. Tsis tas li ntawd, cov ntaub ntawv ua ntej theem 3 tau pom tias muaj kev hloov pauv ntau dua hauv Hb hauv cov neeg mob uas muaj qhov siab C-reactive protein ntau tau txais roxadustat piv rau epoetin alfa (DD-CKD) [91] lossis placebo (NDD-CKD) [98]. Hauv cov neeg mob uas muaj mob me me, uas muaj feem cuam tshuam rau ESA txoj kev kho, HIF-PH inhibitors tuaj yeem yog lwm txoj hauv kev zoo uas zam qhov kev xav tau rau kev kho mob siab ESA. Cov kev tshawb fawb ntxiv yog xav tau kom paub meej tias qhov ua tau zoo ntawm HIF-PH inhibitors hauv cov neeg mob uas ESA hyporesponsive. Thaum kawg, HIF-PH inhibitors tuaj yeem txo qis kev pheej hmoo ntawm cov kab mob plawv piv nrog ESAs hauv qhov xwm txheej lim ntshav cov neeg mob raws li theem ua ntej 3 kev txheeb xyuas tau pom tias muaj kev pheej hmoo tsawg ntawm MACE thiab MACE? nrog roxadustat piv rau epoetin alfa [130]. Cov kev tshawb fawb ntxiv yog xav tau kom paub meej tias cov txiaj ntsig zoo ntawm HIF-PH inhibitors hauv cov neeg mob ntshav qab zib CKD.

Vim tias HIF cov ntsiab lus hloov pauv tswj hwm ntau cov txheej txheem biologic, muaj kev txhawj xeeb tias HIF-PH inhibitors tuaj yeem cuam tshuam rau cov roj cholesterol metabolism [136]. Raws li kev tshawb fawb tsiaj, kev tsim HIF-2 kev ua kom muaj peev xwm tiv thaiv kab mob siab fatty acid oxidation thiab lipid synthesis thiab nce lipid cia muaj peev xwm [136]. Txawm li cas los xij, kev tshawb fawb soj ntsuam tau pom tias txo qis hauv tag nrho thiab qis lipoprotein cholesterol (LDL-C) nrog roxadustat tshaj 19-24 lub lis piam [87, 94] thiab daprodustat tshaj 24 lub lis piam [103] thiab tsis muaj kev hloov pauv hauv cov ntshav lipids nrog vadadustat dhau. 16 lossis 20 lub lis piam [106, 107] thiab tsuas yog hloov me me hauv LDL-C nrog molidustat tshaj 16 lub lis piam [109]. Roxadustat theem 3 cov ntaub ntawv tau pom tias txo qis hauv cov lipoprotein cholesterol tsawg dua piv rau cov placebo (NDD-CKD cov neeg mob) [96] lossis piv rau ESA (DD CKD cov neeg mob) [35]. Ib txoj hauv kev zoo rau qhov txo qis hauv cov roj cholesterol nrog roxadustat yog xav tias yog HIF-nyob ntawm qhov txo qis hauv 3-hydroxy-3-methylglutaryl coenzyme A reductase qib, tus nqi txwv enzyme hauv cov roj cholesterol biosynthesis txoj kev [137 ].

At-Home Anemia Management Kev saib xyuas hauv tsev ntawm CKD yog ib lub hom phiaj uas tau teev tseg hauv Tsab Cai Tswjfwm Ntiag Tug tsis ntev los no, Kev Txhim Kho Kev Noj Qab Haus Huv American Raum, uas yog lub hom phiaj los txhim kho kev kuaj mob thiab kev kho mob ntawm CKD [138]. Piv nrog rau cov pa hemodialysis, cov txiaj ntsig hemodialysis hauv tsev muaj xws li txo qis LV loj thiab kub siab thiab nce HR-QOL, txawm hais tias tsis muaj qhov sib txawv ntawm kev tswj ntshav qab zib [139, 140]. Vim hais tias lawv tau hais lus, HIF-PH inhibitors tuaj yeem muab qhov zoo rau kev saib xyuas hauv tsev CKD. Hauv ESRD cov neeg mob uas tau txais kev lim ntshav peritoneal, qhov kev hloov pauv ntau dua rau kev lim ntshav hauv tsev, roxadustat nce Hb mus rau hauv lub hom phiaj ntau [141], thiab daprodustat pharmacokinetics zoo ib yam hauv cov neeg mob tau txais kev lim ntshav peritoneal lossis hauv nruab nrab hemodialysis, thaum Hb tau khaws cia hauv cov neeg tau txais kev lim ntshav peritoneal [142].

Cov teebmeem ntawm cistanche: kho mob raum

Cov lus xaus

Anemia ntawm CKD sawv cev rau lub nra hnyav rau ob tus neeg mob thiab kev noj qab haus huv. Txawm hais tias muaj txiaj ntsig zoo, tus qauv kev saib xyuas tam sim no cuam tshuam nrog cov teeb meem tshwm sim thiab kev txhawj xeeb txog kev nyab xeeb, suav nrog kev pheej hmoo ntawm cov xwm txheej hauv plawv thiab kev tuag. HIF PH inhibitors tuaj yeem muab qhov zoo dua ESAs dhau los ntawm kev siv lub cev ntau dua thiab muaj txiaj ntsig zoo ntawm kev kho mob ntshav qab zib ntawm CKD.

TXOJ CAI

Nyiaj txiag.Qhov kev tshuaj xyuas no, Kev Pabcuam nrawm, thiab qhib Cov Nqi Nkag tau txais nyiaj los ntawm AstraZeneca.

Editorial Assistance.Sarah Greig, Ph.D. (Auckland, NZ), thiab Meri D. Pozo, Ph.D., CMPP (New York, NY, USA), ntawm inScience Communications, Springer Healthcare tau muab kev pab txhawb nqa, uas tau txais nyiaj los ntawm AstraZeneca.

Kev sau ntawv.Txhua tus kws sau npe ua tau raws li International Committee of Medical Journal Editors (ICMJE) cov txheej txheem rau kev sau ntawv rau tsab xov xwm no, ua lub luag haujlwm rau kev ncaj ncees ntawm kev ua haujlwm tag nrho, thiab tau muab lawv qhov kev pom zoo rau cov ntawv luam tawm no.

Authorship Kev Pabcuam.Txhua tus kws sau ntawv sau thawj tsab ntawv sau tseg thiab koom nrog cov ntawv sau tom ntej, pom zoo xa cov ntawv sau, thiab muaj kev lav phib xaub rau txhua yam ntawm txoj haujlwm.

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