Ogden D A
Department of Medicine, University of Arizona Health Sciences Center, Tucson.
Semin Nephrol. 1989 Mar;9(1 Suppl 2):12-5.
Effective monitoring of chronic hemodialysis patients treated with recombinant human erythropoietin (r-HuEPO; EPOGEN [epoetin alfa], AMGEN Inc, Thousand Oaks, CA) includes an initial evaluation of the patient, the patient's anemia, and the patient's iron stores. Assessment of iron stores includes obtaining hematocrit and hemoglobin levels, reticulocyte count, red cell indices, serum ferritin level, transferrin percent saturation, and the patient's transfusion history. If iron stores are inadequate to support the increased erythropoiesis induced by the therapy, appropriate iron replacement therapy should be provided. Monitoring also involves assessment of BP (and its control), because development or exacerbation of hypertension is the most significant side effect associated with this treatment. Because the dose-response relationship for r-HuEPO therapy has been clearly documented, a target hematocrit and target rate of increase in hematocrit can be established. As anemia improves, continued monitoring of hematocrit, hemoglobin, red cell indices, serum ferritin level, and transferrin percent saturation will ensure that depleted iron stores are noted and treated as necessary. Heparin requirements during dialysis, blood chemistries, and blood access problems should also be monitored. No data currently exist suggesting that dialyzer reuse is compromised by r-HuEPO therapy. Quality-of-life surveys show improvement with r-HuEPO treatment and effective reduction of anemia. There is also some indication that morbidity is lessened and survival improved when anemia is treated with r-HuEPO therapy.
对接受重组人促红细胞生成素（r-HuEPO；利血宝[阿法依泊汀]，安进公司，加利福尼亚州千橡市）治疗的慢性血液透析患者进行有效监测，包括对患者、患者贫血情况以及患者铁储备的初步评估。铁储备评估包括获取血细胞比容和血红蛋白水平、网织红细胞计数、红细胞指数、血清铁蛋白水平、转铁蛋白饱和度百分比以及患者的输血史。如果铁储备不足以支持该疗法诱导的红细胞生成增加，则应提供适当的铁补充疗法。监测还包括评估血压（及其控制情况），因为高血压的发生或加重是与该治疗相关的最显著副作用。由于r-HuEPO治疗的剂量反应关系已得到明确记录，因此可以确定目标血细胞比容和血细胞比容的目标增加率。随着贫血情况改善，持续监测血细胞比容、血红蛋白、红细胞指数、血清铁蛋白水平和转铁蛋白饱和度百分比，将确保发现并在必要时治疗耗尽的铁储备。透析期间的肝素需求量、血液化学指标以及血液通路问题也应进行监测。目前尚无数据表明r-HuEPO治疗会影响透析器复用。生活质量调查显示，r-HuEPO治疗可改善生活质量并有效减轻贫血。也有一些迹象表明，用r-HuEPO治疗贫血时，发病率会降低，生存率会提高。
