Renale Anämie - Hintergründe und Therapiemöglichkeiten

Die TREAT-Studie hat in den internationalen Leitlinien seit 2012 dazu geführt, dass die Zielwerte der Therapie hinsichtlich Hämoglobin angepasst wurden. Für Dialysepatienten wird weiter für den Start einer ESA-Therapie ein Korridor von 9–10 g% Hb angegeben. Der Hb-Wert soll in der Regel unter 11,5 g% liegen, in Einzelfällen werden Werte bis 13 g% akzeptiert. Allerdings verweisen die Leitlinien auch auf die Notwendigkeit zur Individualisierung der Therapie. Insbesondere bei jungen Patienten spielt auch der Aspekt der Leistungsfähigkeit, aber auch der Lebensqualität eine große Rolle, wobei eine neuere Metaanalyse keinen Zusammenhang zwischen der Therapie der renalen Anämie und der Lebensqualität zeigen konnte. Die aktuellen Daten zur Anämietherapie bei Nierenerkrankungen sind hinsichtlich neuer Substanzen spannend und lassen hoffen. Die Nephrologie hat in diesem Feld die Chance, im Sinne der Translation tatsächlich „from bench to bedsite“ neue Therapieprinzipien einzusetzen, um die weiter häufigen Komplikationen, speziell kardiovaskuläre Erkrankungen, adressieren und zu reduzieren. Es wird wichtig bleiben, die aktuelle Studienlage im Blick zu behalten.

Since 2012, the TREAT study has led to an adaptation of the target levels of the therapy regarding hemoglobin in international guidelines. For dialysis patients, a corridor of 9–10 g % Hb is still recommended for an ESA therapy start. Generally, Hb target level should be below 11,5 g %, in isolated cases values of up to 13g % are accepted. However, guidelines also refer to the necessity of an individualized therapy. Especially in young patients, the aspects of performance and quality of life play a major role; hereby, it’s worth mentioning that a new meta-analysis has shown no connection between the therapy of renal anemia and quality of life. Current data regarding therapy of anemia in kidney diseases are fascinating and promising. In this area, nephrology actually has the chance to use new therapy principles in the sense of translation from bench to bedsite in order to address and reduce the still frequent complications, especially cardiovascular diseases. It will remain important to keep track of the status of current studies.

Key words

renal anemia - iron - ESA - EPO - hemoglobin - individualized therapy - kidneys

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