Nephrogenic anemia in patients receiving renal replacement therapy, pathogenesis and resistance


DOI: https://dx.doi.org/10.18565/nephrology.2024.1.58-66

Ryasnyansky V.Yu., Shostka G.D., Anikonova L.I.

1) Department of Nephrology and Dialysis, Pavlov University, St. Petersburg, Russia; 2) City Nephrology Center, City Mariinsky Hospital, St. Petersburg, Russia; 3) Department of Internal Diseases, Clinical Pharmacology and Nephrology, North-Western State Medical University named after. I.I. Mechnikov, St. Petersburg, Russia
The sequence of involvement of factors contributed to the pathogenesis of nephrogenic anemia (NA) begins with the development of nephrosclerosis, retention of uremic toxins and activation of inflammatory cytokines; disturbances in the oxygen sensor in the kidneys, regulation of erythropoiesis, synthesis of endogenous erythropoietin and the development of its deficiency, development of functional iron deficiency and eryptosis are secondary mechanisms for the development of NA. Understanding of these processes serves as the basis for pathogenetic therapy of NA with iron preparations and recombinant human epoetin (rhEPO), which allows achieving the target hemoglobin level in 95% of patients. Transient resistance due to complications of CKD or intercurrent diseases may develop in a significant proportion of patients. What is the role of rhEPO, iron supplements, and prolyl hydroxylase inhibitors in the treatment of resistant anemia? There is no consensus on this issue. Knowledge of the characteristics of NA resistance allows to justify therapeutic tactics, minimizing the risks of using erythropoiesis-stimulating drugs.
Keywords: prolyl hydroxylase inhibitors, hypoxia inducible factor, uremia, nephrogenic anemia, resistance, renal replacement therapy, chronic kidney disease, erythropoietin
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About the Autors

Vladimir Yu. Ryasnyansky – Cand.Sci. (Med.), Associate Professor at the Department of Nephrology and Dialysis, Pavlov University. Address: 6-8 Lev Tolstoy st., St. Petersburg, Russian Federation, 197022. E-mail: meddir@nephromed.ru. https://orcid.org/0009-0004-5886-5709
Georgy D. Shostka – Dr.Sci. (Med.), Professor, City Nephrology Center, City Mariinsky Hospital St. Petersburg. Address: 56 Liteiny pr., St. Petersburg, Russian Federation, 191014. E-mail: shostkaprof@mail.ru
Lyudmila I. Anikonova – Cand.Sci. (Med.), Associate Professor at the Department of Internal Diseases, Clinical Pharmacology and Nephrology, North-Western State Medical University named after. I. I. Mechnikov. Address: 41 Kirochnaya st., St. Petersburg, Russian Federation, 191015. E-mail: anikonovaspb@mail.ru.
https://orcid.org/ 0000-0003-4492-5841


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