Eschbach J W
Department of Medicine, University of Washington, Seattle, USA.
Nephrol Dial Transplant. 1995;10 Suppl 2:96-109. doi: 10.1093/ndt/10.supp2.96.
Since the introduction of recombinant human erythropoietin (r-HuEPO) 9 years ago, there have been tremendous physiological improvements in patients with various anaemias due to absolute and relative erythropoietin (Epo) deficiencies. However, not all patients that could benefit from r-HuEPO are being treated, not all are responding who should be responding, and most dialysis patients (who comprise the single largest group of treatment recipients) are being inadequately treated. The future of r-HuEPO will depend upon whether clinicians can optimize the use of r-HuEPO and determine what should be the optimal haematocrit. These issues will, in turn, depend upon whether three interdependent variables are addressed: the need for more scientific studies to evaluate various aspects of the use and effectiveness of r-HuEPO; the need for physician education to better understand the role of r-HuEPO in optimizing health in patients with anaemia in chronic renal failure and in the anaemia of chronic disease; and the need for less costly r-HuEPO therapy so that more patients can be treated and receive optimal therapy. Better use of r-HuEPO could result in significantly improved morbidity and perhaps improved survival of patients with Epo-deficient anemias.
自从9年前重组人促红细胞生成素（r-HuEPO）问世以来，各种因绝对或相对促红细胞生成素（Epo）缺乏所致贫血患者的生理状况有了极大改善。然而，并非所有能从r-HuEPO中获益的患者都得到了治疗，并非所有应该有反应的患者都有反应，而且大多数透析患者（他们是接受治疗的最大单一群体）的治疗并不充分。r-HuEPO的未来将取决于临床医生能否优化r-HuEPO的使用并确定最佳血细胞比容应该是多少。而这些问题又将取决于是否解决了三个相互关联的变量：需要开展更多科学研究以评估r-HuEPO使用和有效性的各个方面；需要对医生进行教育，使其更好地理解r-HuEPO在优化慢性肾衰竭患者贫血以及慢性病贫血患者健康方面的作用；需要降低r-HuEPO治疗成本，以便更多患者能够接受治疗并获得最佳治疗。更好地使用r-HuEPO可能会显著改善促红细胞生成素缺乏性贫血患者的发病率，甚至可能改善其生存率。
