Is HIF-PHI the Answer to Tackle ESA Hyporesponsiveness in the Elderly?

Kidney and dialysis Pub Date : 2022-08-04 DOI:10.3390/kidneydial2030040

Henry H. L. Wu, R. Chinnadurai, R. Walker

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引用次数: 1

Abstract

Anemia in chronic kidney disease (CKD) has become an important clinical issue with the increased prevalence of elderly patients living with CKD progressing to kidney failure. The causes of anemia in elderly individuals tend to be multifactorial, exacerbated by the physiological effects of aging, frailty and declining kidney function. Erythropoiesis-stimulating agents (ESAs) are the conventional therapeutic option for anemia in CKD. However, ESA hyporesponsiveness is a commonly observed issue in clinical practice and an issue that is more challenging to resolve in elderly patients living with frailty, kidney disease, and multi-morbidities. Following the emergence of oral hypoxia-induced factor prolyl-hydroxylase inhibitors (HIF-PHI) in recent years, there is discussion on whether it is a solution to the conundrum of ESA hyporesponsiveness, as HIF-PHI treats anemia via an alternative physiological pathway. There remains uncertainty on the suitability of HIF-PHI use in elderly patients, given a lack of data on its safety over long-term follow-up for the elderly population. Further study is needed to provide answers, considering the clinical significance of this issue within a public-health scale.

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HIF-PHI是解决老年人ESA低反应性的答案吗？

随着老年CKD患者发展为肾衰竭的患病率增加，慢性肾脏疾病（CKD）中的贫血已成为一个重要的临床问题。老年人贫血的原因往往是多因素的，衰老、虚弱和肾功能下降的生理影响会加剧贫血。促红细胞生成剂（ESA）是CKD贫血的常规治疗选择。然而，ESA低反应性是临床实践中常见的问题，在患有虚弱、肾病和多种疾病的老年患者中更难解决。近年来，随着口服缺氧诱导因子脯氨酰羟化酶抑制剂（HIF-PHI）的出现，人们讨论它是否能解决ESA低反应性的难题，因为HIF-HI通过一种替代的生理途径治疗贫血。鉴于缺乏对老年人群长期随访的安全性数据，HIF-PHI在老年患者中的适用性仍存在不确定性。考虑到这一问题在公共卫生范围内的临床意义，需要进一步的研究来提供答案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Kidney and dialysis

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