It Is Urgent To Improve The Diagnosis And Treatment Of Anemia in Maintenance Hemodialysis Patients!

Renal anemia is a common complication in patients with chronic kidney disease. Improving the control rate of renal anemia has become one of the goals of improving the quality of nephrology care. The current management of renal anemia in maintenance hemodialysis patients is not ideal, which is manifested in two aspects: First, the prevalence rate is high. Relevant data shows that the prevalence of peritoneal anemia in my country is 53.5%, and the prevalence of anemia in maintenance hemodialysis patients is 53.5%. The incidence rate is as high as 90%. Second, the treatment compliance rate is low. Although the anemia treatment compliance rate has increased in recent years, it is still not ideal. The current peritoneal dialysis anemia compliance rate in my country is 31.08%, and the maintenance hemodialysis anemia compliance rate is only 21.3%. In Japan, , and North America, less than 10% of patients have hemoglobin lower than 90 g/L. It can be seen that my country still faces challenges in the prevention and treatment of renal anemia [1].

Click to Cistanche for kidney disease

1. Pay attention to maintenance hemodialysis

Reasons for the high incidence of anemia

(1) Erythropoietin (EPO) deficiency. This is the fundamental cause of anemia in maintenance hemodialysis patients. EPO is a peptide hormone secreted by the human kidney. It can increase the production of red blood cells by bone marrow, increase hemoglobin content, and increase the oxygen-carrying and oxygen-supplying capacity of the blood. If the kidney function is damaged, EPO will not be secreted enough, causing anemia.

(2) Insufficient hematopoietic raw materials. Hemoglobin and iron are the main substances that make up red blood cells. Folic acid and vitamin b12 are red blood cell growth factors. These hematopoietic "raw materials" are indispensable. Since dialysis patients need to strictly restrict their diet, etc., they are prone to a lack of hematopoietic raw materials in the body, leading to anemia.

(3) Red blood cells undergo rapid apoptosis and are lost a lot. The average life span of normal red blood cells is 120 days. Dialysis is insufficient and toxins remain at a high level, resulting in the life span of red blood cells in dialysis patients being only 60 to 90 days. At the same time, due to the long-term use of anticoagulant drugs, the clotting time is prolonged and the risk of bleeding is high. After dialysis, a small amount of red blood cells remain in the dialyzer and tubes, which over time leads to greater loss of red blood cells.

(4) Bleeding. Hemodialysis patients often have bleeding tendencies, such as bleeding in the nose, gums, and gastrointestinal tract, leading to renal anemia.

(5) Others. For example, in secondary hyperparathyroidism, parathyroid hormone can antagonize EPO and inhibit red blood cell production, which can increase the fragility of red blood cells and shorten the life of red blood cells.

2. Pay attention to maintenance hemodialysis

Early patient screening and diagnosis

Early screening and diagnosis are of great significance to the prevention and control of anemia in maintenance hemodialysis patients. Currently, the diagnosis of anemia in maintenance hemodialysis patients is based on the diagnostic criteria for renal anemia. According to the "Clinical Practice Guidelines for the Diagnosis and Treatment of Renal Anemia in China (2021 Edition)" formulated by the Renal Anemia Guidelines Working Group of the Nephrology Physicians Branch of the Chinese Medical Doctor Association, the diagnosis of renal anemia must meet the following requirements.

(1) Determine whether anemia exists. For adults living in sea-level areas, anemia can be diagnosed if Hb is <130 g/L for men, Hb is <120 g/L for non-pregnant women, and Hb is <110 g/L for pregnant women; however, the age, race, and place of residence of the patient should be considered. Effect of altitude on Hb.

(2) Determine whether there is an anemic disease other than renal anemia. Diagnosis can only be made after clarifying whether there is malnutrition anemia, hemolytic anemia, hemorrhagic anemia, and anemia caused by blood system diseases. The specific diagnostic process and monitoring indicators are shown in Figure 1.

(3) Diagnose whether there are risk factors for aggravating renal anemia. Such as severe iron deficiency; secondary hyperparathyroidism; inflammatory state; malnutrition, etc.

3. Pay attention to the exploration of maintenance hemodialysis treatment measures

(1) Erythropoiesis stimulating agents (ESAs). ESAs include short-acting ESAs and long-acting ESAs. Erythropoietin is mainly secreted by renal cortical interstitial cells and acts on bone marrow hematopoietic stem cells to promote hemoglobin synthesis and red blood cell release. As kidney function declines, its deficiency gradually increases. Therefore, exogenous supplementation of ESAs is an important method for the treatment of renal anemia.

Recombinant human erythropoietin is the only ESA marketed in my country. They are short-acting ESAs and can be administered by subcutaneous or intravenous injection. Subcutaneous injection has a longer half-life and is administered every 2 to 7 days. Research shows that recombinant human erythropoietin can not only effectively improve patients' anemia, but also improve patients' life endurance and delay changes in cardiac structure. It is an important drug for the treatment of anemia in hemodialysis patients. In addition, compared with shorter-acting ESAs, long-acting ESAs can reduce the number of patient injections, reduce patient pain, and reduce the amount of iron consumed during erythropoiesis, but their safety requires further study.

(2) Iron supplement. Iron is an important hematopoietic raw material in the body. Maintenance hemodialysis patients suffer from iron loss or affect the absorption of iron in the gastrointestinal tract due to factors such as residual blood in the dialysis tubing and dietary restrictions. Most dialysis patients have varying degrees of iron deficiency or deficiency. It is generally believed that serum ferritin (SF) ≤100 μg/L and transferrin saturation (TSAT) ≤20% in non-dialysis CKD or peritoneal dialysis patients; SF≤200 μg/L and TSAT≤20% in hemodialysis patients are absolute. Iron deficiency requires the initiation of iron therapy. It is recommended that TSAT in CKD anemia patients be maintained at 30% to 50% and SF>100 μg/L (SF>200 μg/L in hemodialysis patients) as the target of iron metabolism indicators.

Iron can be supplemented by oral administration, intravenous injection, or intramuscular injection. Because iron ions greatly stimulate intramuscular tissue, iron supplementation by intramuscular injection is rarely used. Oral iron preparations include ferrous iron and ferric iron. Commonly used ferrous irons include ferrous fumarate and ferrous sulfate. Ferric iron includes polysaccharide iron, lipid iron, and malt iron. The dose of oral iron is usually 150 to 200 mg/d (elemental iron). If the hemoglobin and iron status still cannot reach the target during the reexamination after 1 to 3 months, or the patient has severe adverse reactions, intravenous iron supplementation still needs to be initiated.

(3) Hepcidin antagonist. PRS080 has a high affinity to hepcidin and is a hepcidin antagonist. In a study involving 24 hemodialysis patients, it was found that IPRS080 could increase transferrin levels and improve anemia by inhibiting hepcidin. It is expected to be used in the treatment of renal anemia in the future.

(4) Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs). HIF-PHIs is a new type of small molecule oral drug for the treatment of renal anemia. It stabilizes HIF levels in the body by inhibiting HIF prolyl hydroxylase, thereby regulating the transcription and expression of target genes downstream of the HIF signaling pathway. HIF-PHIs comprehensively regulate the body to promote the production of red blood cells by promoting the production and receptor expression of endogenous physiological concentrations of EPO, promoting the expression of proteins related to iron metabolism, and at the same time reducing hepcidin levels.

(5) FGF23 inhibitors. Elevated FGF23 levels will increase the risk of death from cardiovascular events in patients with chronic kidney disease and may promote the occurrence of anemia. In a mouse model of renal failure, it was found that inhibiting the FGF23 signaling pathway with a peptide antagonist can stimulate erythropoiesis and reduce erythrocyte apoptosis. , increasing ferritin levels. Therefore, exploring the inhibition of the FGF23 signaling pathway is expected to open up new avenues for the treatment of renal anemia.

4. Summary

The prevention and treatment of renal anemia in hemodialysis patients has a long way to go. Paying attention to the key points of prevention and treatment of renal anemia in hemodialysis patients and exploring more new technologies and drugs are of great significance to delaying the further occurrence and development of renal anemia in patients.

How Does Cistanche Treat Kidney Disease?

Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.

Kidney disease, also known as renal disease, refers to a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.

Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.

Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.

Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.

Furthermore, cistanche has been shown to have immunomodulatory effects. In kidney disease, the immune system can be dysregulated, leading to excessive inflammation and tissue damage. Cistanche helps regulate the immune response by modulating the production and activity of immune cells, such as T cells and macrophages. This immune regulation helps reduce inflammation and prevent further damage to the kidneys.

Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.

In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.

In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.