维持性血液透析患者促红细胞生成素低反应性与不良预后的研究进展

Research Progress on Erythropoiesis-Stimulating Agent Hyporesponsiveness and Adverse Prognosis in Patients on Maintenance Hemodialysis

摘要: 慢性肾脏病患者由于内源性促红细胞生成素相对或者绝对缺乏导致贫血，其发生率随着慢性肾脏病的进展而增加，在维持性血液透析患者中尤为突出。红细胞生成素刺激剂(ESAs)是治疗肾性贫血的主要手段，但仍有一部分患者对ESA不敏感或者需要更多的剂量才能达到目标血红蛋白值，这可能是ESA低反应性或者抵抗。近年来许多研究开始关注ESA低反应性对患者预后的影响，本文旨在系统性梳理ESA低反应性与维持性血液透析患者心血管事件、全因死亡率、脑血管事件及复合事件的关联并探讨其临床意义同时提出低反应患者临床管理路径。

Abstract: Patients with chronic kidney disease (CKD) frequently develop anemia due to relative or absolute deficiency of endogenous erythropoietin, with its prevalence increasing as CKD progresses and becoming particularly prominent among those on maintenance hemodialysis. Erythropoiesis-stimulating agents (ESAs) constitute the primary therapeutic approach for renal anemia; however, a subset of patients exhibit inadequate response or require higher doses to maintain target hemoglobin levels, a condition defined as ESA hyporesponsiveness. In recent years, a growing body of research has focused on the prognostic implications of ESA hyporesponsiveness. This review systematically examines the associations between ESA hyporesponsiveness and adverse outcomes—including cardiovascular events, all-cause mortality, cerebrovascular events, and composite endpoints—in patients undergoing maintenance hemodialysis, discusses the clinical significance of these associations, and proposes a practical management pathway for patients with ESA hyporesponsiveness.