Paulitschke M, Ludat K, Riedel E, Hampl H
Cell-Lining GmbH, Berlin, Germany.
Clin Nephrol. 2000 Feb;53(1 Suppl):S36-41.
Successful treatment of renal anemia with recombinant erythropoietin (rhEPO) raises the question of whether the renal anemia symptom complex requires complete correction. Current arguments against increasing hemoglobin (Hb) levels above 10-11 g/dl are impaired hemodynamics, increased risk of vascular access occlusion, unmanageable hypertension and dialysis complications. The aim of the study was to determine whether sustained Hb normalization using long-term rhEPO causes hemorheological changes with a potentially negative hemodynamic impact. The study was conducted in 42 rhEPO-treated dialysis patients with stable Hb > 11.0 g/dl for at least 20 weeks. The mean Hb of the total study group was 12.8 1.1 g/dl. To study the effect of Hb as a risk indicator in greater detail, the patients were divided into two groups, with hematocrits above and below 0.40. Hemorheology (erythrocyte deformability and aggregation, plasma viscosity) showed no significant changes, including vs a healthy control group. Throughout the period of increased rhEPO administration, no increase was observed in the incidence of hypertension or vascular thrombosis.
the marked additional quality-of-life benefit achieved by complete correction of renal anemia harbors no substantial increase in treatment risk.
用重组促红细胞生成素（rhEPO）成功治疗肾性贫血引发了一个问题，即肾性贫血症状复合体是否需要完全纠正。目前反对将血红蛋白（Hb）水平提高到10 - 11g/dl以上的理由包括血流动力学受损、血管通路闭塞风险增加、难以控制的高血压和透析并发症。本研究的目的是确定长期使用rhEPO使Hb持续正常化是否会引起血液流变学变化，并对血流动力学产生潜在的负面影响。该研究对42例接受rhEPO治疗且Hb稳定>11.0g/dl至少20周的透析患者进行。整个研究组的平均Hb为12.8±1.1g/dl。为了更详细地研究Hb作为风险指标的影响，将患者分为两组，血细胞比容分别高于和低于0.40。血液流变学（红细胞变形性和聚集性、血浆粘度）未显示出显著变化，与健康对照组相比也是如此。在增加rhEPO给药的整个期间，高血压或血管血栓形成的发生率没有增加。
完全纠正肾性贫血所带来的显著额外生活质量益处并不会大幅增加治疗风险。
