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

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Abstract

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.

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About the authors

Vladimir Yu. Ryasnyansky

Pavlov University

Author for correspondence.
Email: meddir@nephromed.ru
ORCID iD: 0009-0004-5886-5709

Cand.Sci. (Med.), Associate Professor at the Department of Nephrology and Dialysis

Russian Federation, St. Petersburg

Georgy D. Shostka

City Nephrology Center, City Mariinsky Hospital

Email: shostkaprof@mail.ru

Dr.Sci. (Med.), Professor

Russian Federation, St. Petersburg

Lyudmila I. Anikonova

North-Western State Medical University named after. I.I. Mechnikov

Email: anikonovaspb@mail.ru
ORCID iD: 0000-0003-4492-5841

Cand.Sci. (Med.), Associate Professor at the Department of Internal Diseases, Clinical Pharmacology and Nephrology

Russian Federation, St. Petersburg

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