Carrera Fernando, Disney Alex, Molina Manuel
Eurodial, Dialysis Unit, Rua da Carrasqueira 19, Parceiros, 2400-441, Leiria, Portugal.
Nephrol Dial Transplant. 2007 Jun;22 Suppl 4:iv19-iv30. doi: 10.1093/ndt/gfm162.
The recombinant human erythropoietins epoetins alfa and beta have relatively short half-lives ( approximately 24 h by subcutaneous route) and have traditionally been administered 2 or 3 times a week for the treatment of anaemia in patients with chronic kidney disease. However, multiple weekly injections are inconvenient for both the patient and the healthcare provider. With the introduction of the longer-acting erythropoiesis-stimulating agent darbepoetin alfa, there has been growing interest in longer dosing intervals for erythropoiesis-stimulating agents. Data from several randomized studies have shown that darbepoetin alfa is effective in maintaining haemoglobin levels when administered (subcutaneously, intravenously or both) every 2 weeks in dialysis patients, and every 2 weeks or monthly in patients with chronic kidney disease not yet receiving dialysis. Moreover, intravenous administration with darbepoetin alfa does not require a higher dosage compared with the subcutaneous route. Epoetins alfa and beta have also been studied in similar schedules, although few data from well-designed studies are available. Current data suggest that once-weekly administration of these forms of epoetin is feasible in dialysis patients, but dose increases are often required when switching patients from traditional twice- or thrice-weekly schedules. Also, administration of epoetins every other week is feasible in selected patients with chronic renal insufficiency. Further study is required to clarify the optimum schedule for epoetins in these settings.
重组人促红细胞生成素α和β的半衰期相对较短（皮下注射约24小时），传统上每周给药2或3次，用于治疗慢性肾病患者的贫血。然而，每周多次注射对患者和医护人员来说都不方便。随着长效促红细胞生成素刺激剂α-达贝泊汀的引入，人们对延长促红细胞生成素刺激剂的给药间隔越来越感兴趣。几项随机研究的数据表明，α-达贝泊汀在透析患者中每2周（皮下、静脉或两种途径）给药一次，在尚未接受透析的慢性肾病患者中每2周或每月给药一次时，对维持血红蛋白水平有效。此外，与皮下途径相比，α-达贝泊汀静脉给药不需要更高的剂量。促红细胞生成素α和β也在类似的给药方案中进行了研究，尽管来自精心设计研究的数据很少。目前的数据表明，在透析患者中每周一次给药这些形式的促红细胞生成素是可行的，但当患者从传统的每周两次或三次给药方案转换时，通常需要增加剂量。此外，在选定的慢性肾功能不全患者中，每两周给药一次促红细胞生成素也是可行的。需要进一步研究以阐明在这些情况下促红细胞生成素的最佳给药方案。
