红色素形成刺激剂用于预防急性损伤
Hiroki Nishiwaki1,2,3, Yoshifusa Abe4, Taihei Suzuki5
1Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan.
The Cochrane database of systematic reviews
|September 20, 2024
概括
红色素形成刺激剂 (ESA) 可能不会降低急性损伤 (AKI) 或风险患者死亡的风险. 建议在使用ESA用于AKI预防时谨慎使用,因为目前的证据显示益处很小,甚至没有.
科学领域:
- 腎病學和重症醫療醫學 腎病學和重症醫學
- 药理学和治疗学 药理学和治疗学
- 临床试验分析
背景情况:
- 急性损伤 (AKI) 是一种常见的,严重的疾病,在住院成年人中发生率很高.
- 红色素形成刺激剂 (ESAs) 在动物模型中已经证明了脏保护作用.
- 之前对ESA用于AKI预防的系统审查缺乏.
研究的目的:
- 系统地审查红色素形成刺激剂 (ESA) 预防急性损伤 (AKI) 的益处和危害.
- 为了评估ESA在各种健康状况中对AKI的疗效和安全性.
主要方法:
- 随机对照试验 (RCT) 和准RCT的系统审查和元分析.
- 搜索了主要的数据库,包括Cochrane脏和移植注册表,MEDLINE,EMBASE和临床试验注册表.
- 三位独立作者进行数据提取和偏差风险评估;用于证据确定性的GRADE方法.
主要成果:
- 包括20项研究,5348名参与者;大多数有不清楚或高风险的报道偏见.
- 在预防 AKI (RR 0.97,中度确定性) 或死亡 (RR 0.92,中度确定性) 方面,ESA 几乎没有差异.
- 在透析启动,血栓形成或其他不良事件中没有观察到显著差异;结果在各子组中一致.
结论:
- 红色素形成刺激剂 (ESAs) 可能不会降低风险患者的AKI或死亡风险.
- ESA不能降低启动透析的需要或影响功能和不良事件.
- 建议在使用ESA预防AKI时谨慎使用;正在进行的研究可能会改变结论.
相关概念视频
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
396
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
396
Antihypertensive Drugs: Direct Renin Inhibitors
508
The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys,...
508
Erythropoiesis
4.1K
Red blood cells (RBCs) transport oxygen to all body tissues. These cells survive only for 120 days and then need to be replenished. Erythropoiesis is the process of RBC production. In healthy individuals, erythropoiesis ensures all tissues are amply supplied with oxygen. In addition, blood loss due to injury leads to a drop in the physiological oxygen level that will cause erythropoiesis. Any defect in erythropoiesis leads to several physiological disorders, including thalassemia, anemia,...
4.1K
Renal Failure: Dose Adjustments
68
In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
68
Dialysis
276
Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
276
Renal Drug Excretion: Tubular Secretion
152
Active tubular secretion is a robust, energy-demanding process that utilizes carrier systems to transport drugs into renal tubules. The active renal secretion systems include the organic anion transporter (OAT) for weak acids and the organic cation transporter (OCT) for weak bases. Structurally similar drugs can compete for the same transporter, potentially leading to drug accumulation and toxicity. However, this principle can be exploited therapeutically. One example is probenecid (Probalan),...
152


