Возможности коррекции нефрогенной анемии у пациента с ВИЧ и хронической болезнью почек
Возможности коррекции нефрогенной анемии у пациента с ВИЧ и хронической болезнью почек
Фомин В.В. Возможности коррекции нефрогенной анемии у пациента с ВИЧ и хронической болезнью почек. Consilium Medicum. 2024;26(10):698–703. DOI: 10.26442/20751753.2024.10.203048
Fomin VV. Options for correcting nephrogenic anemia in a patient with HIV and chronic kidney disease. Case report. Consilium Medicum. 2024;26(10):698–703. DOI: 10.26442/20751753.2024.10.203048
Возможности коррекции нефрогенной анемии у пациента с ВИЧ и хронической болезнью почек
Фомин В.В. Возможности коррекции нефрогенной анемии у пациента с ВИЧ и хронической болезнью почек. Consilium Medicum. 2024;26(10):698–703. DOI: 10.26442/20751753.2024.10.203048
Fomin VV. Options for correcting nephrogenic anemia in a patient with HIV and chronic kidney disease. Case report. Consilium Medicum. 2024;26(10):698–703. DOI: 10.26442/20751753.2024.10.203048
Анемия – отличительное проявление хронической болезни почек (ХБП), она выявляется уже с III стадии ХБП и наблюдается у подавляющего большинства больных с терминальной почечной недостаточностью. Основной механизм почечной анемии – снижение продукции эндогенного эритропоэтина, но также в патогенезе важную роль играют дефицитные состояния, хроническое воспаление и гиперпаратиреоз. Основным методом лечения анемии при ХБП является применение эритропоэз-стимулирующих препаратов (ЭСП), которые делятся на коротко действующие и длительно действующие. У пациентов с терминальной почечной недостаточностью, находящихся на гемодиализе, приоритетный препарат для лечения анемии – эритропоэтин альфа. Однако в некоторых случаях развивается резистентность к ЭСП, что осложняет лечение. Одна из причин формирования резистентности к ЭСП – воспалительный процесс. В статье представлен клинический случай пациента с ВИЧ 1-го типа, вирусом гепатита С и терминальной ХБП, требующей программного гемодиализа, тяжелой анемией и резистентностью к проводимой терапии.
Anemia is a distinctive manifestation of chronic kidney disease (CKD); it occurs already from stage III CKD and is observed in the vast majority of patients with end-stage renal disease. The primary mechanism of renal anemia is a decrease in the production of endogenous erythropoietin; deficiency conditions, chronic inflammation, and hyperparathyroidism also play an essential role in pathogenesis. The main therapy for anemia in CKD is erythropoiesis-stimulating agents (ESAs), which are divided into short-acting and long-acting. In patients with end-stage renal disease on hemodialysis, the preferred treatment for anemia is erythropoietin alfa. However, in some cases, ESA resistance develops, which complicates treatment. One of the reasons for the emergence of ESA resistance is the inflammatory process. The article presents a clinical case of a patient with HIV type 1, hepatitis C infection, and ESRD requiring long term hemodialysis, severe anemia, and resistance to current therapy.
1. Evans M, Bower H, Cockburn E, et al. Contemporary management of anaemia, erythropoietin resistance and cardiovascular risk in patients with advanced chronic kidney disease: a nationwide analysis. Clin Kidney J. 2020;13(5):821-7. DOI:0.1093/ckj/sfaa054
2. GBD Chronic Kidney Disease Collaboration: Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395:709-33. DOI:10.1016/S0140-6736(20)30045-3
3. Lim C, Ng RWC, Cheng N, et al. Advance care planning for haemodialysis patients. Cochrane Database Syst Rev. 2016;7(7):CD010737. DOI:10.1002/14651858.CD010737.pub2
4. Locatelli F, Nissenson AR, Barrett BJ, et al. Clinical practice guidelines for anemia in chronic kidney disease: problems and solutions. A position statement from Kidney Disease Improving Global Outcomes (KDIGO). Kidney Int. 2008;74:1237-40.
5. Милованова Л.Ю., Милованов Ю.С., Козловская Л.В. Эритропоэтины длительного действия в лечении нефрогенной анемии. Урология и нефрология. Спецвыпуск «Актуальные вопросы нефрологии». 2012;11:16-9 [Milovanova LIu, Milovanov IuS, Kozlovskaia LV. Eritropoetiny dlitel'nogo deistviia v lechenii nefrogennoi anemii. Urologiia i nefrologiia. Spetsvypusk “Aktual'nye voprosy nefrologii”. 2012;11:16-9 (in Russain)].
6. Анемия при хронической болезни почек. Клинические рекомендации. 2024. Режим доступа: https://cr.minzdrav.gov.ru/schema/623_42. Ссылка активна на 18.09.2024 [Anemiia pri khronicheskoi bolezni pochek. Klinicheskie rekomendatsii. 2024. Available at: https://cr.minzdrav.gov.ru/schema/623_42. Accessed: 18.09.2024 (in Russain)].
7. Azmandian J, Abbasi MR, Pourfarziani V, et al. Comparing therapeutic efficacy and safety of epoetin beta and epoetin alfa in the treatment of anemia in end-stage renal disease hemodialysis patients. Am J Nephrol. 2018;48(4):251-9. DOI:10.1159/000493097
8. Oka S, Obata Y, Torigoe K, et al. A comparative study of the hemoglobin-maintaining effects between epoetin beta-pegol and Darbepoetin-alpha in patient with chronic kidney disease during 3 months before dialysis initiation. Drugs R D. 2017;17(3):389-96. DOI:10.1007/s40268-017-0188-6
9. Hörl WH. Differentiating factors between erythropoiesis-stimulating agents: an update to selection for anaemia of chronic kidney disease. Drugs. 2013;73(2):117-30. DOI:10.1007/s40265-012-0002-2
10. Ostrvica E, Mesic E, Ostrvica D, et al. Effectiveness of treating renal anemia in the chronic hemodialyzed patients by Epoetin alpha and beta. Med Arh. 2010;64(1):1-6.
11. Jelkmann W. Renal erythropoietin: properties and production. Rev Physiol Biochem Pharmacol. 1986;104:139-217.
12. Deicher R, Horl WH. Differentiating factors between erythropoiesis stimulating agents: a guide to selection for anemia of chronic kidney disease. Drugs. 2004;64(5):499-509.
13. Sinha SD, Bandi VK, Bheemareddy BR, et al. Efficacy, tolerability, and safety of darbepoetin alfa injection for the treatment of anemia associated with chronic kidney disease (CKD) undergoing dialysis: a randomized, phase III trial. BMC Nephrol. 2019;20(19):1-9.
14. Carrera F, Burnier M. Use of darbepoetin alfa in the treatment of anemia of chronic kidney disease: clinical and pharmacoeconomic considerations. NDT Plus. 2009;2(1):9-17.
15. Macdougall IC, Kai-Uwe E. Novel strategies for stimulating erythropoiesis and potential new treatments for anaemia. Lancet. 2006;368:947-53. DOI:10.1016/S0140-6736(06)69120-4
16. Abracchio MP, Zanella A. Therapy perspectives. L’eritropoietina e la regolazione della massa eritroide. Adis a Wolter Kluwer business, 2006.
17. Locatelli F, Pozzoni P, Vecchio LD. Recombinant human epoetin beta in the treatment of renal anemia. Ther Clin Risk Manag. 2007;3(3):433-9.
18. Locatelli F, Covic A, Eckardt KU, et al. Anaemia management in patients with chronic kidney disease: a position statement by the Anaemia Working Group of European Renal Best Practice (ERBP). Nephrol Dial Transplant. 2009;24(2):348-54. DOI:10.1093/ndt/gfn653
19. Eschbach JW, Abdulhadi MH, Browne JK, et al. Recombinant Human Erythropoietin in Anemic Patients with End-Stage Renal Disease: Results of a Phase III Multicenter Clinical Trial. Ann Intern Med. 1989;111(12):992-1000. DOI:10.7326/0003-4819-111-12-992
20. KDOQI; National Kidney Foundation. KDOQI clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease. Am J Kidney Dis. 2006;47(5 Suppl. 3):S11-145.
21. Locatelli F, Aljama P, Bárány P, et al.; European Best Practice Guidelines Working Group. Revised European best practice guidelines for the management of anaemia in patients with chronic renal failure. Nephrol Dial Transplant. 2004;19 Suppl. 2:ii1-47. DOI:10.1093/ndt/gfh1032
22. Panichi V, Rosati A, Bigazzi R, et al. Anaemia and resistance to erythropoiesis-stimulating agents as prognostic factors in haemodialysis patients: results from the RISCAVID study. Nephrol Dial Transplant. 2011;26(8):2641-8. DOI:10.1093/ndt/gfq802
23. Regidor DL, Kopple JD, Kovesdy CP, et al. Associations between changes in hemoglobin and administered erythropoiesis-stimulating agent and survival in hemodialysis patients. J Am Soc Nephrol. 2006;17(4):1181-91.
24. de Lurdes Agostinho Cabrita A, Pinho A, Malho A, et al. Risk factors for high erythropoiesis stimulating agent resistance index in pre-dialysis chronic kidney disease patients, stages 4 and 5. Int Urol Nephrol. 2011;43(3):835-40. DOI:10.1007/s11255-010-9805-9
25. Won HS, Kim HG, Yun YS, et al. IL-6 is an independent risk factor for resistance to erythropoiesis-stimulating agents in hemodialysis patients without iron deficiency. Hemodial Int. 2012;16(1):31-7. DOI:10.1111/j.1542-4758.2011.00635.x
26. Shankar A, Sun L, Klein BE, et al. Markers of inflammation predict the long-term risk of developing chronic kidney disease: a population-based cohort study. Kidney Int. 2011;80(11):1231-8.
27. Stinghen AE, Bucharles S, Riella MC, Pecoits-Filho R. Immune mechanisms involved in cardiovascular complications of chronic kidney disease. Blood Purif. 2010;29(2):114-20. DOI:10.1159/000245636
28. Yilmaz MI, Solak Y, Covic A, et al. Renal anemia of inflammation: the name is self-explanatory. Blood Purif. 2011;32(3):220-5. DOI:10.1159/000328037
29. Bruggeman LA, Bark C, Kalayjian RC. HIV and the Kidney. Curr Infect Dis Rep. 2009;11:479-85.
30. Margolick JB, Jacobson LP, Schwartz GJ, et al. Factors affecting glomerular filtration rate, as measured by iohexol disappearance, in men with or at risk for HIV infection. PLoS One. 2014;9:e86311.
31. Ng DK, Jacobson LP, Brown TT, et al. HIV therapy, metabolic and cardiovascular health are associated with glomerular hyperfiltration among men with and without HIV infection. AIDS. 2014;28:377-86.
32. Lazarus Jeffrey V, Laut KG, Safreed-Harmon K, et al. Disparities in HIV clinic care across Europe: Findings from the EuroSIDA clinic survey. BMC Infect Dis. 2016;16:335. DOI:10.1186/s12879-016-1685-x
33. Mohan S, Herlitz LC, Tan J, et al. The changing pattern of glomerular disease in HIV and hepatitis C co-infected patients in the era of HAART. Clin Nephrol. 2013;79:285-91.
34. Markowitz GS, Nasr SH, Stokes MB, D’Agati VD. Treatment with IFN-alpha, -beta, or -gamma is associated with collapsing focal segmental glomerulosclerosis. Clin J Am Soc Nephrol. 2010;5:607-15.
35. Volberding PA, Levine AM, Dieterich D, et al. Anemia in HIV infection: clinical impact and evidence-based management strategies. Clin Infect Dis. 2004;38:1454-63.
36. Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005;352:1011-23.
37. Kimel M, Leidy NK, Mannix S, Dixon J. Does epoetin alfa improve health-related quality of life in chronically ill patients with anemia? Summary of trials of cancer, HIV/AIDS, and chronic kidney disease. Value in Health. 2008;11(1):57-75.
38. Henry DH, Beall GN, Benson CA, et al. Recombinant Human Erythropoietin in the Treatment of Anemia Associated with Human Immunodeficiency Virus (HIV) Infection and Zidovudine Therapy. Ann Intern Med. 1992;117(9):739-48. DOI:10.7326/0003-4819-117-9-739
________________________________________________
1. Evans M, Bower H, Cockburn E, et al. Contemporary management of anaemia, erythropoietin resistance and cardiovascular risk in patients with advanced chronic kidney disease: a nationwide analysis. Clin Kidney J. 2020;13(5):821-7. DOI:0.1093/ckj/sfaa054
2. GBD Chronic Kidney Disease Collaboration: Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395:709-33. DOI:10.1016/S0140-6736(20)30045-3
3. Lim C, Ng RWC, Cheng N, et al. Advance care planning for haemodialysis patients. Cochrane Database Syst Rev. 2016;7(7):CD010737. DOI:10.1002/14651858.CD010737.pub2
4. Locatelli F, Nissenson AR, Barrett BJ, et al. Clinical practice guidelines for anemia in chronic kidney disease: problems and solutions. A position statement from Kidney Disease Improving Global Outcomes (KDIGO). Kidney Int. 2008;74:1237-40.
5. Milovanova LIu, Milovanov IuS, Kozlovskaia LV. Eritropoetiny dlitel'nogo deistviia v lechenii nefrogennoi anemii. Urologiia i nefrologiia. Spetsvypusk “Aktual'nye voprosy nefrologii”. 2012;11:16-9 (in Russain).
6. Anemiia pri khronicheskoi bolezni pochek. Klinicheskie rekomendatsii. 2024. Available at: https://cr.minzdrav.gov.ru/schema/623_42. Accessed: 18.09.2024 (in Russain).
7. Azmandian J, Abbasi MR, Pourfarziani V, et al. Comparing therapeutic efficacy and safety of epoetin beta and epoetin alfa in the treatment of anemia in end-stage renal disease hemodialysis patients. Am J Nephrol. 2018;48(4):251-9. DOI:10.1159/000493097
8. Oka S, Obata Y, Torigoe K, et al. A comparative study of the hemoglobin-maintaining effects between epoetin beta-pegol and Darbepoetin-alpha in patient with chronic kidney disease during 3 months before dialysis initiation. Drugs R D. 2017;17(3):389-96. DOI:10.1007/s40268-017-0188-6
9. Hörl WH. Differentiating factors between erythropoiesis-stimulating agents: an update to selection for anaemia of chronic kidney disease. Drugs. 2013;73(2):117-30. DOI:10.1007/s40265-012-0002-2
10. Ostrvica E, Mesic E, Ostrvica D, et al. Effectiveness of treating renal anemia in the chronic hemodialyzed patients by Epoetin alpha and beta. Med Arh. 2010;64(1):1-6.
11. Jelkmann W. Renal erythropoietin: properties and production. Rev Physiol Biochem Pharmacol. 1986;104:139-217.
12. Deicher R, Horl WH. Differentiating factors between erythropoiesis stimulating agents: a guide to selection for anemia of chronic kidney disease. Drugs. 2004;64(5):499-509.
13. Sinha SD, Bandi VK, Bheemareddy BR, et al. Efficacy, tolerability, and safety of darbepoetin alfa injection for the treatment of anemia associated with chronic kidney disease (CKD) undergoing dialysis: a randomized, phase III trial. BMC Nephrol. 2019;20(19):1-9.
14. Carrera F, Burnier M. Use of darbepoetin alfa in the treatment of anemia of chronic kidney disease: clinical and pharmacoeconomic considerations. NDT Plus. 2009;2(1):9-17.
15. Macdougall IC, Kai-Uwe E. Novel strategies for stimulating erythropoiesis and potential new treatments for anaemia. Lancet. 2006;368:947-53. DOI:10.1016/S0140-6736(06)69120-4
16. Abracchio MP, Zanella A. Therapy perspectives. L’eritropoietina e la regolazione della massa eritroide. Adis a Wolter Kluwer business, 2006.
17. Locatelli F, Pozzoni P, Vecchio LD. Recombinant human epoetin beta in the treatment of renal anemia. Ther Clin Risk Manag. 2007;3(3):433-9.
18. Locatelli F, Covic A, Eckardt KU, et al. Anaemia management in patients with chronic kidney disease: a position statement by the Anaemia Working Group of European Renal Best Practice (ERBP). Nephrol Dial Transplant. 2009;24(2):348-54. DOI:10.1093/ndt/gfn653
19. Eschbach JW, Abdulhadi MH, Browne JK, et al. Recombinant Human Erythropoietin in Anemic Patients with End-Stage Renal Disease: Results of a Phase III Multicenter Clinical Trial. Ann Intern Med. 1989;111(12):992-1000. DOI:10.7326/0003-4819-111-12-992
20. KDOQI; National Kidney Foundation. KDOQI clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease. Am J Kidney Dis. 2006;47(5 Suppl. 3):S11-145.
21. Locatelli F, Aljama P, Bárány P, et al.; European Best Practice Guidelines Working Group. Revised European best practice guidelines for the management of anaemia in patients with chronic renal failure. Nephrol Dial Transplant. 2004;19 Suppl. 2:ii1-47. DOI:10.1093/ndt/gfh1032
22. Panichi V, Rosati A, Bigazzi R, et al. Anaemia and resistance to erythropoiesis-stimulating agents as prognostic factors in haemodialysis patients: results from the RISCAVID study. Nephrol Dial Transplant. 2011;26(8):2641-8. DOI:10.1093/ndt/gfq802
23. Regidor DL, Kopple JD, Kovesdy CP, et al. Associations between changes in hemoglobin and administered erythropoiesis-stimulating agent and survival in hemodialysis patients. J Am Soc Nephrol. 2006;17(4):1181-91.
24. de Lurdes Agostinho Cabrita A, Pinho A, Malho A, et al. Risk factors for high erythropoiesis stimulating agent resistance index in pre-dialysis chronic kidney disease patients, stages 4 and 5. Int Urol Nephrol. 2011;43(3):835-40. DOI:10.1007/s11255-010-9805-9
25. Won HS, Kim HG, Yun YS, et al. IL-6 is an independent risk factor for resistance to erythropoiesis-stimulating agents in hemodialysis patients without iron deficiency. Hemodial Int. 2012;16(1):31-7. DOI:10.1111/j.1542-4758.2011.00635.x
26. Shankar A, Sun L, Klein BE, et al. Markers of inflammation predict the long-term risk of developing chronic kidney disease: a population-based cohort study. Kidney Int. 2011;80(11):1231-8.
27. Stinghen AE, Bucharles S, Riella MC, Pecoits-Filho R. Immune mechanisms involved in cardiovascular complications of chronic kidney disease. Blood Purif. 2010;29(2):114-20. DOI:10.1159/000245636
28. Yilmaz MI, Solak Y, Covic A, et al. Renal anemia of inflammation: the name is self-explanatory. Blood Purif. 2011;32(3):220-5. DOI:10.1159/000328037
29. Bruggeman LA, Bark C, Kalayjian RC. HIV and the Kidney. Curr Infect Dis Rep. 2009;11:479-85.
30. Margolick JB, Jacobson LP, Schwartz GJ, et al. Factors affecting glomerular filtration rate, as measured by iohexol disappearance, in men with or at risk for HIV infection. PLoS One. 2014;9:e86311.
31. Ng DK, Jacobson LP, Brown TT, et al. HIV therapy, metabolic and cardiovascular health are associated with glomerular hyperfiltration among men with and without HIV infection. AIDS. 2014;28:377-86.
32. Lazarus Jeffrey V, Laut KG, Safreed-Harmon K, et al. Disparities in HIV clinic care across Europe: Findings from the EuroSIDA clinic survey. BMC Infect Dis. 2016;16:335. DOI:10.1186/s12879-016-1685-x
33. Mohan S, Herlitz LC, Tan J, et al. The changing pattern of glomerular disease in HIV and hepatitis C co-infected patients in the era of HAART. Clin Nephrol. 2013;79:285-91.
34. Markowitz GS, Nasr SH, Stokes MB, D’Agati VD. Treatment with IFN-alpha, -beta, or -gamma is associated with collapsing focal segmental glomerulosclerosis. Clin J Am Soc Nephrol. 2010;5:607-15.
35. Volberding PA, Levine AM, Dieterich D, et al. Anemia in HIV infection: clinical impact and evidence-based management strategies. Clin Infect Dis. 2004;38:1454-63.
36. Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005;352:1011-23.
37. Kimel M, Leidy NK, Mannix S, Dixon J. Does epoetin alfa improve health-related quality of life in chronically ill patients with anemia? Summary of trials of cancer, HIV/AIDS, and chronic kidney disease. Value in Health. 2008;11(1):57-75.
38. Henry DH, Beall GN, Benson CA, et al. Recombinant Human Erythropoietin in the Treatment of Anemia Associated with Human Immunodeficiency Virus (HIV) Infection and Zidovudine Therapy. Ann Intern Med. 1992;117(9):739-48. DOI:10.7326/0003-4819-117-9-739
Авторы
В.В. Фомин*
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*fomin_v_v_1@staff.sechenov.ru