Di Paolo B, Marini A, Fiederling B, Di Liberato L, Santarelli P, Bucciarelli S, Stuard S, Paolantonio L, Albertazzi A
Department of Nephrology and Dialysis, University of Chieti, Italy.
Perit Dial Int. 1993;13 Suppl 2:S538-40.
The use of recombinant human erythropoietin (rHuEPO) has revolutionized the treatment of renal anemia, but the dose regimens, the optimal frequency, and the effects on other target organs like the central nervous systems (CNS) are still under discussion. We designed a prospective, ongoing study with 10 stable continuous ambulatory peritoneal dialysis (CAPD) patients (6 males, 4 females; mean age 64.4 +/- 7.8 years), with a pretreatment hemoglobin (Hb) < 7.0 g% and requiring regular blood transfusions. Seven patients were treated with 4000 U rHuEPO once weekly (Eritrogen, Boehringer Mannheim), 2 patients received 4000 U every 5 and 8 days, and the last one 4000 U every 10 days. The target hematocrit was 33% and Hb 10.0 g%. The CNS activity was recorded as visual (VEP), brainstem (BAER), and somatosensory (SEP)-evoked potentials. The mean Hb concentration increased from 6.9 +/- 1.2 g% to 10.3 +/- 1.6 g% (p < 0.001) over 8 weeks. There were no significant changes in urea, creatinine, and potassium levels, and urine output. rHuEPO induced a decrease in latency of P100 VEP, in the four main components of BAER, and in the P27-N35 intertime of SEP. Parallel to the improvement of red cell indices, patients experienced a dramatic improvement in well-being. The subcutaneous administration of a single vial of rHuEPO is safe, convenient, and inexpensive in CAPD. The role of rHuEPO treatment in improving the electrophysiological brain function in uremic and anemic patients remains to be studied and may not necessarily be based on improved cerebral oxygenation.
重组人促红细胞生成素（rHuEPO）的应用彻底改变了肾性贫血的治疗方式，但给药方案、最佳用药频率以及对中枢神经系统（CNS）等其他靶器官的影响仍在讨论之中。我们设计了一项前瞻性、正在进行的研究，纳入10例稳定的持续性非卧床腹膜透析（CAPD）患者（6例男性，4例女性；平均年龄64.4±7.8岁），这些患者治疗前血红蛋白（Hb）<7.0 g%且需要定期输血。7例患者每周皮下注射1次4000 U rHuEPO（利血宝，勃林格殷格翰公司），2例患者分别每5天和8天接受4000 U注射，最后1例患者每10天接受4000 U注射。目标血细胞比容为33%，Hb为10.0 g%。通过视觉诱发电位（VEP）、脑干听觉诱发电位（BAER）和体感诱发电位（SEP）记录中枢神经系统活动。8周内，平均Hb浓度从6.9±1.2 g%升至10.3±1.6 g%（p<0.001）。尿素、肌酐、钾水平及尿量无显著变化。rHuEPO使P100 VEP潜伏期、BAER的四个主要成分以及SEP的P27 - N35间期缩短。随着红细胞指标的改善，患者的健康状况也显著改善。在CAPD患者中，皮下注射单瓶rHuEPO安全、方便且费用低廉。rHuEPO治疗对改善尿毒症贫血患者脑电生理功能的作用仍有待研究，其机制不一定基于改善脑氧合。
