Abstract：
Anemia is a common complication of chronic kidney disease (CKD). The insufficient erythropoietin (EPO) production by the kidneys and iron deficiency are the main causes. Iron supplementation and the administration of recombinant EPO are the main treatment modalities. New iron formulations that can be administered orally, intravenously or directly via the dialysate have recently been developed to improve efficacy and tolerance. Ferric citrate administered orally can effectively corrects anemia in case of iron deficiency and in addition chelate phosphate in the gut lumen. Ferric carboxymaltose allows intravenous administration of larger doses given less frequently. Ferric pyrophosphate citrate administered directly via the dialysate allows the compensation of iron losses during the hemodialysis session. HIF-prolyl-hydroxylase inhibitors are a new therapeutic class of erythropoiesis-stimulating agents. Orally administered, they act by stabilizing the HIF transcription factor involved in the initiation of erythropoietin production by hypoxia. Several clinical studies have recently evaluated these new molecules in comparison with recombinant EPO. In CKD patients not yet on dialysis or undergoing dialysis therapy non-inferiority in correcting anemia has been demonstrated compared with recombinant EPO. The decrease in circulating hepcidin they induce appears greater than that induced by injectable recombinant EPO. Presently available reports on the safety of HIF-prolyl-hydroxylase inhibitors are reassuring but need to be confirmed in longer-term studies of larger size. © 2022 Published by Elsevier Masson SAS on behalf of Société francophone de néphrologie, dialyse et transplantation.
摘要：
贫血是慢性肾脏病(CKD)的常见并发症。肾脏产生的促红细胞生成素（EPO）不足和缺铁是主要原因。补充铁和施用重组EPO是主要的治疗方式。可以口服的新铁制剂，最近已经开发了静脉内或直接通过透析液来改善功效和耐受性。在缺铁的情况下，口服柠檬酸铁可以有效地纠正贫血，此外还可以在肠腔中螯合磷酸盐。羧基麦芽糖铁允许静脉内给予较低频率的较大剂量。经由透析液直接施用的柠檬酸焦磷酸铁允许在血液透析期间补偿铁损失。HIF-脯氨酸酰-羟化酶抑制剂是一类新的红细胞生成刺激剂。口服药,它们通过稳定HIF转录因子起作用,所述HIF转录因子参与缺氧启动促红细胞生成素的产生。一些临床研究最近评估了这些新分子与重组EPO的比较。与重组EPO相比，在尚未接受透析或接受透析治疗的CKD患者中，已证明在纠正贫血方面具有非劣效性。它们诱导的循环铁调素的减少似乎大于可注射重组EPO诱导的减少。目前有关HIF-脯氨酸酰-羟化酶抑制剂安全性的报道令人放心，但需要在更大规模的长期研究中得到证实。©2022由ElsevierMassonSAS代表法国法语国家集团发布，透析et移植。
