Besarab A, Ross R P, Nasca T J
Department of Medicine, Ford Hospital, Detroit, Michigan, USA.
Curr Opin Nephrol Hypertens. 1995 Mar;4(2):155-61. doi: 10.1097/00041552-199503000-00008.
Recombinant human erythropoietin is increasingly used to treat anemia in predialysis patients. Approximately 33-40% of patients ultimately receiving dialysis or a transplant may be eligible for treatment, thus increasing the costs. Clinical trials demonstrate no significant alteration in the progression of renal disease, secondary to changes in systemic hemodynamics or blood volume, provided that blood pressure is controlled. Hypertension results from changes in viscosity and erythrocyte fluidity, loss of hypoxic vasodilatation, and changes in blood volume. The predialysis patient treated with recombinant human erythropoietin is likely to need aggressive antihypertensive therapy and vigorous diuresis. Cardiac output remains unchanged in the absence of blood volume expansion. The effects on left ventricular hypertrophy, left ventricular volume, or exercise-induced ischemic electrocardiographic changes in predialysis have not been studied systematically. Doses of recombinant human erythropoietin in predialysis patients tend to be lower when administered subcutaneously rather than intravenously, but the comparative cost-effectiveness of different dosing strategies is currently unknown. The dosing frequency can vary from three times a week to twice a month. The effect of anemia correction on the 'rehabilitation' of predialysis patients remains to be addressed.
重组人促红细胞生成素越来越多地用于治疗透析前患者的贫血。最终接受透析或移植的患者中约有33%-40%可能符合治疗条件，从而增加了成本。临床试验表明，只要血压得到控制，由于全身血流动力学或血容量的变化，肾脏疾病的进展不会有显著改变。高血压是由粘度和红细胞流动性的变化、缺氧性血管舒张的丧失以及血容量的变化引起的。接受重组人促红细胞生成素治疗的透析前患者可能需要积极的抗高血压治疗和强力利尿。在没有血容量扩张的情况下，心输出量保持不变。对透析前左心室肥厚、左心室容积或运动诱发的缺血性心电图变化的影响尚未进行系统研究。透析前患者皮下注射重组人促红细胞生成素的剂量往往低于静脉注射，但目前尚不清楚不同给药策略的相对成本效益。给药频率可以从每周三次到每月两次不等。纠正贫血对透析前患者“康复”的影响仍有待探讨。
