فقر الدم في أمراض الكلى المزمنة (غير الخاضعين لغسيل الكلى): ماذا تفعل عندما لا يُجدي علاج عوامل تحفيز تكوين الكريات الحمراء نفعاً

References

DOI: 10.1016/j.kint.2025.06.006

In people with CKD not receiving dialysis, including kidney transplant recipients and children, the selection of Hb concentration at which ESA therapy is initiated should consider the presence of symptoms attributable to anemia, the potential benefits of higher Hb concentration, and the potential harms of RBC transfusions or ESA therapy (2D).

In people with CKD, anemia, and ESA hyporesponsiveness, if there is a desire to raise Hb to avoid transfusion or improve symptoms attributable to anemia, a trial course of HIF-PHI may be considered after discussion of potential risks and benefits (Figure 10).

In people with anemia and CKD not receiving dialysis or with CKD G5D who have active malignancy, a recent cardiovascular event, or recent vascular thrombosis, do not use HIF-PHIs.

In people with anemia and CKD, including those with ESA hyporesponsiveness, do not use ESAs and HIF-PHIs in combination.

In people with anemia and CKD, discontinue HIF-PHI after 3–4 months if a desired erythropoietic response has not been achieved.

In people with anemia and CKD, when administering HIF-PHIs, monitor Hb levels 2–4 weeks after initiation or dose adjustments and subsequently every 4 weeks during therapy.