Kronik Böbrek Hastalıklarında Aneminin Değerlendirilmesi ve Tedavisi

Kronik böbrek hastalıklarında anemi sık görülmektedir. Anemi, kardiyovasküler hastalık için önemli bir risk faktörüdür ve yaşam kalitesini etkilemektedir. Böbreklerden eritropoetin (EPO) sentezinin azalması aneminin esas nedenidir. Diğer nedenler arasında demir eksikliği, inflamasyon, üremik toksinler, hiperparatiroidi, hemoliz, eritrosit yaşam süresinin azalması ve malnütrisyon sayılabilir. Anemi tedavisinde öncelikle anemiye yol açan nedenler araştırılmalı ve nedene yönelik tedavi yapılmalıdır. Kronik böbrek hastalarında anemi tedavisinin temelini eritropoez stimüle edici ajanlar (ESA) oluşturur. Aneminin diğer nedenleri dışlandıktan sonra hastaya ESA tedavisi başlanmalıdır. Hedef hemoglobin değeri 11-12 g/dL olmalıdır. ESA ile tedaviye başlanmadan önce mutlaka demir eksikliği değerlendirilmeli ve demir eksikliği varsa tedavi edilmelidir. Kronik böbrek hastasında demir eksikliğinin değerlendirilmesinde pratikte en sık kullanılan parametreler transferrin satürasyonu (TSAT) ve ferritin düzeyidir. Serum ferritin konsantrasyonu

Evaluation and Treatment of Anemia in Chronic Kidney Disease

Anemia is common in patients with chronic kidney disease. Anemia is a major risk factor for cardiovascular disease and affects life quality. The reduction of renal erythropoietin synthesis is the essentially cause of anemia. Among other reasons can considered iron deficiency, inflammation, uremic toxins, hyperparathyroidism, hemolysis, reduction of erythrocyte survival and malnutrition. The reasons that lead to anemia should be investigated primarily in the treatment of anemia and treatment should be for the cause. Erythropoiesis-stimulating agents is the basis of the treatment of anemia in chronic kidney disease. ESA therapy should be initiated to patient after the ruled out other causes of anemia. The target hemoglobin value should be 11-12 g/dL. Iron deficiency must be evaluated before starting treatment with erythropoiesis stimulating agents and should be treated if any iron deficiency. Transferrin saturation (TSAT) and ferritin level is the most commonly used parameters in the evaluation of iron deficiency in chronic kidney disease in practice. Iron therapy should be given if serum ferritin concentrations

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