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Dialyse aktuell 2017; 21(05): 232-218
DOI: 10.1055/s-0043-107872
Schwerpunkt | Nephrologie
© Georg Thieme Verlag Stuttgart · New York

Behandlung der renalen Anämie

Neue therapeutische Ansätze
Patrick Biggar
1   Nephrologie, Klinikum Coburg GmbH, Coburg
2   KfH-Nierenzentrum, Coburg
,
Gero von Gersdorff
3   Klinik II für Innere Medizin – QiN-Gruppe, Uniklinik Köln
4   KfH-Nierenzentrum, Köln
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Publication History

Publication Date:
17 July 2017 (online)

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ZUSAMMENFASSUNG

Anämie stellt, ob als subjektiv empfundene Einschränkung oder als Marker interpretiert, ein signifikanter, prognostischer Parameter in der Entwicklung der CKD dar. Ausgehend von der Isolierung und Herstellung von EPO bzw. ESAs haben Studien gezeigt, dass eine Hb-Anhebung auf bis zu 10 g/dl mit klinischen Vorteilen einhergeht. Allerdings konnte bislang nicht überzeugend nachgewiesen werden, dass eine intensivierte Hb-Anhebung mittels exogener Zufuhr von EPO einen umfassenden Benefit für den Patienten bedeutet. Neuere Entwicklungen versprechen interessante Ansätze, in denen nicht nur die Erythropoese im engeren Sinne stimuliert wird, sondern darüber hinausgehende Mechanismen moduliert werden. Die Activin-Hemmung birgt das Potenzial nicht nur die Anämie, sondern auch den Mineral- und Knochenerkrankungen-Komplex (CKD-MBD) bei Niereninsuffizienz zu verbessern. Die HIF-Prolyl-Hydroxylase-Inhibitoren zeigen auch pleiotrope Wirkungen, die derzeit im Mittelpunkt weiterer Forschungen stehen. Allerdings bieten die konventionellen ESAs einen umfassenden Sicherheitsgrad, an dem die neueren Substanzen gemessen werden dürften. Die Entwicklung eines Blutschlauchsystems für die Hämodialyse stellt einen gänzlich anderen Ansatz dar, um die Anämie zu verbessern. Hier wird nicht eine Stimulierung der Erythropoese, sondern eine unverfängliche Reduzierung einer mechanischen Hämolyse während der Dialyse erreicht.

 

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