Zachée P
Division of Haematology, University of Leuven, Belgium.
Drugs. 1995 Apr;49(4):536-47. doi: 10.2165/00003495-199549040-00004.
Epoetin (recombinant human erythropoietin) is now a widely available though expensive treatment for the anaemia of chronic renal failure, and is effective in more than 95% of patients. Complications of epoetin in this context include hypertension in a third of cases, including hypertensive encephalopathy in a few, and thrombosis of shunts or vascular access devices. Fears that epoetin would cause progression of renal failure have not generally been confirmed, but hyperkalaemia may be a problem in the initial phase of treatment. Epoetin is up to twice as effective when administered subcutaneously rather than intravenously. Responding patients will normally do so within 3 months of starting epoetin. Failures to respond are usually due to iron deficiency or intercurrent disease. Other diseases associated with anaemia and an inappropriately low serum epoetin level include prematurity, the anaemia of cancer and rheumatoid arthritis. The baseline serum endogenous erythropoietin may provide a guide to response in some of these cases. Some encouraging results are being published. Situations where the serum erythropoietin levels are normal or elevated where epoetin has been employed include boosting of haematocrit presurgery as an adjunct to autologous blood donation, treatment of anaemic patients with myelodysplastic syndromes, and improvement of athletic performances.
促红细胞生成素（重组人促红细胞生成素）目前是一种广泛应用但价格昂贵的治疗慢性肾衰竭贫血的药物，对超过95%的患者有效。在此情况下，促红细胞生成素的并发症包括三分之一的患者出现高血压，少数患者出现高血压脑病，以及分流器或血管通路装置血栓形成。关于促红细胞生成素会导致肾衰竭进展的担忧通常未得到证实，但高钾血症可能是治疗初期的一个问题。皮下注射促红细胞生成素的效果是静脉注射的两倍。有反应的患者通常在开始使用促红细胞生成素后的3个月内出现反应。无反应通常是由于缺铁或并发疾病。与贫血和血清促红细胞生成素水平异常降低相关的其他疾病包括早产、癌症贫血和类风湿关节炎。在某些情况下，基线血清内源性促红细胞生成素水平可能为反应提供指导。一些令人鼓舞的结果正在发表。使用促红细胞生成素时血清促红细胞生成素水平正常或升高的情况包括术前提高血细胞比容作为自体献血的辅助手段、治疗骨髓增生异常综合征的贫血患者以及提高运动成绩。
