Borrelli S, Baldanza D, Scigliano R, Catapano F, Grimaldi M, Calabria M, Zamboli P, Minutolo R, De Nicola L, Conte G
Cattedra di Nefrologia, Seconda Universita' degli Studi, Napoli, Italy.
G Ital Nefrol. 2009 Jan-Feb;26(1):31-7.
In the last twenty years, erythropoiesis-stimulating agents (ESAs) have improved the management of renal anemia, with significant amelioration of quality of life in patients on hemodialysis. ESAs can be administered both intravenously and subcutaneously. In predialysis chronic kidney disease and in peritoneal dialysis, the administration route is necessarily subcutaneous. In hemodialysis the intravenous route was initially preferred because of the presence of ready vascular access for drug administration. Subsequent studies have demonstrated that the subcutaneous route allowed the achievement of optimal levels of hemoglobin with a reduction of mean administered dose, number of injections, and costs. A few years ago, the finding of a higher risk of pure red cell aplasia associated with subcutaneous administration of epoetin reopened the debate about the route of administration. We here review the studies on the preferable route of administration of epoetin and darbepoetin- alpha, in terms of efficacy and safety, and take a look at future perspectives.
在过去二十年中，促红细胞生成素（ESAs）改善了肾性贫血的治疗，显著提高了血液透析患者的生活质量。ESAs 既可以静脉注射，也可以皮下注射。在透析前慢性肾脏病和腹膜透析中，给药途径必须是皮下注射。在血液透析中，由于有现成的血管通路用于药物给药，最初首选静脉途径。随后的研究表明，皮下途径能够在降低平均给药剂量、注射次数和成本的情况下达到最佳血红蛋白水平。几年前，发现皮下注射促红细胞生成素会增加纯红细胞再生障碍性贫血的风险，这再次引发了关于给药途径的争论。我们在此根据疗效和安全性对促红细胞生成素和聚乙二醇化促红细胞生成素-α 的优选给药途径的研究进行综述，并展望未来前景。
