Paganini E P
Department of Nephrology/Hypertension, Cleveland Clinic Foundation, OH 44195-5241.
Am J Kidney Dis. 1994 Jul;24(1 Suppl 1):S10-6; discussion S31-2.
Anemia is an inevitable and potentially serious complication of chronic renal failure and one of the most important limiting factors in patient rehabilitation. Although adequate dialysis can control many of the symptoms of uremia, dialysis does not reverse anemia-associated fatigue, and thus, many patients are not rehabilitated. Human recombinant erythropoietin (epoetin) therapy has proven to be effective in reversing anemia and increasing hematocrit levels in the majority of patients with chronic renal failure. Among this patient population, increases in hematocrit level have resulted in improvements in the symptomatology of organ hypoxia, neurobehavioral indices, anorexia, insomnia, depression, and sexual disinterest and dysfunction, as well as a reduction in cardiomegaly. However, despite the availability of epoetin and the dramatic improvements in the complications associated with the anemic state observed following therapy, it appears that patient rehabilitation remains a challenge. One aspect of the continuing problem of rehabilitation appears to be the reluctance of the medical community to increase hematocrit levels above 30%, despite the fact that higher hematocrit levels are associated with greater improvements and that potential adverse events related to hemodynamic adaptation are manageable. Indeed, a comparison of the results from two Epoetin alfa clinical trials, one in which hematocrit levels were maintained at 35% and a large phase IV study in which the target hematocrit level appears to have been approximately 30%, clearly demonstrate the benefits of optimizing hematocrit levels and thus improving the potential for rehabilitation.
贫血是慢性肾衰竭不可避免且可能严重的并发症，也是患者康复的最重要限制因素之一。尽管充分透析可控制许多尿毒症症状，但透析并不能逆转与贫血相关的疲劳，因此，许多患者无法康复。已证明，人重组促红细胞生成素（促红素）疗法在逆转大多数慢性肾衰竭患者的贫血并提高血细胞比容水平方面是有效的。在这类患者群体中，血细胞比容水平的提高已使器官缺氧症状、神经行为指标、厌食、失眠、抑郁以及性兴趣和性功能得到改善，同时心脏扩大也有所减轻。然而，尽管有促红素可用，且治疗后观察到与贫血状态相关的并发症有显著改善，但患者康复似乎仍然是一项挑战。康复问题持续存在的一个方面似乎是，尽管较高的血细胞比容水平与更大改善相关，且与血液动力学适应相关的潜在不良事件是可控的，但医学界仍不愿将血细胞比容水平提高到30%以上。事实上，两项促红细胞生成素α临床试验结果的比较，一项将血细胞比容水平维持在35%，另一项大型IV期研究的目标血细胞比容水平似乎约为30%，清楚地证明了优化血细胞比容水平从而提高康复潜力的益处。
