Anemi ve Kanıta Dayalı Tedavi Bakım Uygulamaları
Özet
Anemi, hemodiyaliz tedavisi alan hastalarda yaygın bir komplikasyondur ve hastaların yaşam kalitesini önemli ölçüde düşürür. Yorgunluk, halsizlik, egzersiz kapasitesinde azalma gibi semptomlarla günlük aktiviteleri kısıtlar; hospitalizasyon riskini, kognitif bozuklukları, kardiyovasküler hastalıkları ve mortaliteyi artırır. Kronik böbrek hastalığının her evresinde görülür, prevalansı evre ilerledikçe artar; diyaliz hastalarında yaklaşık %66-90'a ulaşır. Etiyolojisi multifaktöriyel olup, EPO üretim eksikliği, demir eksikliği (mutlak/fonksiyonel), kronik inflamasyon, üremik toksinler, sık kan kayıpları, beslenme yetersizlikleri ve enfeksiyonlar başlıca nedenlerdir. Bu faktörler, kemik iliği eritropoeizini baskılar, kırmızı kan hücresi ömrünü kısaltır ve hepsidin aracılığıyla demir kullanımını engeller. Anemi yönetimi, eritropoiezi uyarıcı ajanlar ve intravenöz demir takviyeleriyle kritik öneme sahiptir; hemoglobin hedeflerini korur, transfüzyon ihtiyacını azaltır ve klinik sonuçları iyileştirir. Erken teşhis ve kanıta dayalı bakım uygulamaları, morbiditeyi önler. Bu bölümde, hemodiyaliz hastalarında aneminin epidemiyolojisi, patofizyolojisi ve güncel tedavi stratejileri değerlendirilmektedir. Bu kapsamda, renal anemiye yönelik tedavi yaklaşımları, özellikle eritropoiez uyarıcı ajanların kullanımı ve demir takviyeleri, uluslararası kılavuzlar doğrultusunda belirlenen hemoglobin hedef aralıklarını korumayı amaçlamaktadır.
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