维持性血液透析合并肾性贫血的药物研究进展

Research Progress on Pharmacotherapy for Renal Anemia in Maintenance Hemodialysis Patients

摘要: 维持性血液透析(Maintenance Hemodialysis, MHD)患者合并肾性贫血，是终末期肾病患者常见的并发症之一，其发生机制复杂，主要与肾脏促红细胞生成素(Erythropoietin, EPO)分泌不足、铁代谢紊乱、慢性炎症、尿毒症毒素蓄积及红细胞寿命缩短等因素有关。肾性贫血可显著降低患者的生活质量，并增加心血管事件、住院及死亡风险。目前，红细胞生成刺激剂(Erythropoiesis-Stimulating Agents, ESAs)联合合理补铁仍是主要治疗策略；长效ESAs可减少给药频次，已逐步应用于临床；低氧诱导因子脯氨酰羟化酶抑制剂(Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitors, HIF-PHIs)作为新型治疗药物，为部分患者提供了新的治疗选择；左卡尼汀则主要用于辅助治疗。近年来，肾性贫血的治疗逐渐向个体化、联合化及长效化方向发展，但ESA低反应、功能性铁缺乏、药物长期安全性及最佳联合方案等问题仍有待进一步研究。本文就MHD患者肾性贫血的药物治疗进展进行综述。

Abstract: Renal anemia is a common complication in patients with end-stage kidney disease undergoing maintenance hemodialysis (MHD). Its pathogenesis is complex and is primarily associated with inadequate renal erythropoietin (EPO) production, disordered iron metabolism, chronic inflammation, the accumulation of uremic toxins, and shortened erythrocyte lifespan. Renal anemia can significantly impair patients’ quality of life and increase the risks of cardiovascular events, hospitalization, and mortality. Currently, erythropoiesis-stimulating agents (ESAs) combined with appropriate iron supplementation remain the mainstay of treatment. Long-acting ESAs can reduce dosing frequency and have been gradually adopted in clinical practice. Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs), as a novel class of therapeutic agents, provide an additional treatment option for selected patients, whereas L-carnitine is primarily used as adjunctive therapy. In recent years, the management of renal anemia has increasingly shifted toward individualized, combination-based, and long-acting treatment strategies. However, several issues require further investigation, including ESA hyporesponsiveness, functional iron deficiency, the long-term safety of therapeutic agents, and optimal combination regimens. This article reviews recent advances in the pharmacological treatment of renal anemia in patients undergoing MHD.