Нефрогенная анемия у пациентов, получающих заместительную почечную терапию, патогенез и резистентность


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

Ряснянский В.Ю., Шостка Г.Д., Аниконова Л.И.

1) Кафедра нефрологии и диализа ФПО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова», Санкт-Петербург, Россия; 2) Городской нефрологический центр Санкт-Петербургское ГБУЗ «Городская Мариинская больница», Санкт-Петербург, Россия; 3) Кафедра внутренних болезней, клинической фармакологии и нефрологии ФГБОУ «Северо-Западный государственный медицинский университет им. И.И. Мечникова», Санкт-Петербург, Россия
Последовательность вовлечения факторов, принимающих участие в патогенезе нефрогенной анемии (НА), дебютирует с развития нефросклероза, ретенции уремических токсинов и активации воспалительных цитокинов, в качестве вторичных механизмов развития НА присоединяются нарушения кислородного сенсора в почках, регуляции эритропоэза, синтеза эндогенного эритропоэтина и развитие его дефицита, развитие функционального дефицита железа и эриптоз. Понимание этих процессов служит основой патогенетической терапии НА препаратами железа и рекомбинантного человеческого эпоэтина (рчЭПО), которая позволяет достичь целевого уровня гемоглобина у 95% пациентов. Преходящая резистентность на фоне осложнений ХБП или интеркуррентных заболеваний может развиваться у значительной части пациентов. Какова роль в лечении резистентной анемии рчЭПО, препаратов железа и ингибиторов пролилгидроксилаз? Консенсус по этому вопросу отсутствует. Знание особенностей резистентности НА позволяет обосновать терапевтическую тактику, минимизируя риски применения эритропоэзстимулирующих препаратов.
Ключевые слова: ингибиторы пролилгидроксилаз, гипоксией индуцируемый фактор, уремия, нефрогенная анемия, резистентность, заместительная почечная терапия, хроническая болезнь почек, эритропоэтин
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Об авторах / Для корреспонденции

Ряснянский Владимир Юрьевич – к.м.н., доцент кафедры нефрологии и диализа ФПО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова». Адрес: 197022, Российская Федерация, Санкт-Петербург, ул. Льва Толстого, д. 6-8. E-mail: meddir@nephromed.ru. https://orcid.org/0009-0004-5886-5709
Шостка Георгий Дмитриевич – д.м.н. профессор, городской нефрологический центр Санкт-Петербургское государственное бюджетное учреждение здравоохранения «Городская Мариинская больница». Адрес: 191014, Российская Федерация, Санкт-Петербург, Литейный пр-т, 56. E-mail: shostkaprof@mail.ru
Аниконова Людмила Ивановна – к.м.н., доцент кафедры внутренних болезней, клинической фармакологии и нефрологии ФГБОУ СЗГМУ им. И. И. Мечникова. Адрес: 191015 Российская Федерация, Санкт-Петербург, ул. Кирочная, 41. E-mail: anikonovaspb@mail.ru. https://orcid.org/ 0000-0003-4492-5841


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