Eschbach J W
Department of Medicine, University of Washington, Seattle 98195.
Am J Kidney Dis. 1991 Oct;18(4 Suppl 1):3-9.
Recombinant human erythropoietin (epoetin) is a remarkably safe and effective biological product. Many dialysis patients are benefiting from the use of this drug when administered intravenously (IV) or subcutaneously (SC) three times a week. However, many patients are not receiving optimal therapy. Optimal therapy requires an understanding of the principles of effective usage and a definition of an optimal hematocrit (Hct) level. These therapeutic principles include (1) the erythroid response to epoetin is dose-dependent, but variable within a given dose; (2) the SC route of injection is as effective, if not more so, than IV injections; (3) the frequency of administration is route-dependent; (4) adequate iron stores are necessary for optimal response; (5) blood pressure may increase as the Hct increases, but may improve with time due to hemodynamic adjustments; (6) the anemia is primarily a hormone-deficiency state and not due to uremia; and (7) infections and traumatic (ie, surgical) inflammation may blunt the response to epoetin. Many patients with the anemia of renal failure have yet to benefit from treatment. These include patients with progressive renal failure or chronic transplant rejection, and dialysis patients who have had incomplete correction of their anemia.
重组人促红细胞生成素（促红素）是一种极为安全有效的生物制品。许多透析患者通过每周静脉注射（IV）或皮下注射（SC）三次使用这种药物而获益。然而，许多患者并未接受最佳治疗。最佳治疗需要理解有效使用的原则以及确定最佳血细胞比容（Hct）水平。这些治疗原则包括：（1）促红细胞生成素对红细胞生成的反应呈剂量依赖性，但在给定剂量内存在差异；（2）皮下注射途径即使不比静脉注射更有效，至少也是同样有效的；（3）给药频率取决于给药途径；（4）充足的铁储备是获得最佳反应所必需的；（5）随着血细胞比容升高，血压可能会升高，但由于血液动力学调整，血压可能会随时间改善；（6）贫血主要是一种激素缺乏状态，而非由尿毒症引起；（7）感染和创伤性（即手术）炎症可能会削弱对促红细胞生成素的反应。许多肾衰竭贫血患者尚未从治疗中获益。这些患者包括进行性肾衰竭或慢性移植排斥患者，以及贫血未得到完全纠正的透析患者。
