Duckham J M, Lee H A
Q J Med. 1976 Apr;45(178):277-94.
Twelve anephric patients on maintenance haemodialysis received treatment with oral enteric coated cobalt chloride 25 to 50 mg daily. The change in haemoglobin concentration, and packed cell volume, are recorded and discussed with special reference to possible toxicity and mechanism of action of cobalt. Six of eight patients who completed the first course with cobalt chloride 50 mg daily for 12 weeks showed a significant rise in haemoglobin concentration of 26 to 70 per cent and a fall to near pre-therapeutic levels when cobalt was withdrawn. Evidence of a response was present within two months of starting treatment. Four patients showed a diminution in their blood transfusion requirements and three patients experienced a definite sense of increased well-being during treatment. One patient suffered from side effects of the drug and failed to complete the study because of gastrointestinal disturbance. The improvment in haemoglobin concentration was reproducible in four patients who were given second, and in one case third courses courses with varying doses of cobalt over differing periods of time. Serum cobalt levels tended to stabilize after two months continuous treatment to the therapeutic range of 40-100 mumg per 100 ml. A rapid fall in serum cobalt was seen on cessation of treatment. It is suggested that therapy with enteric coated cobalt chloride at a dose of between 25 and 50 mg per day has a definite place in the treatment of the refractory anaemia of chronic renal failure.
12名维持性血液透析的无肾患者接受了口服肠溶氯化钴治疗，每日剂量为25至50毫克。记录并讨论了血红蛋白浓度和红细胞压积的变化，并特别提及钴可能的毒性和作用机制。8名患者中，有6名完成了每日50毫克氯化钴的第一疗程，为期12周，其血红蛋白浓度显著升高了26%至70%，在停用钴后降至接近治疗前水平。在开始治疗后的两个月内就出现了反应的迹象。4名患者的输血需求减少，3名患者在治疗期间明显感觉身体状况有所改善。1名患者出现药物副作用，因胃肠道紊乱未能完成研究。4名接受第二疗程、1名接受第三疗程不同剂量钴治疗且疗程不同的患者，血红蛋白浓度均有改善。连续治疗两个月后，血清钴水平趋于稳定在每100毫升40 - 100微克的治疗范围内。停止治疗后，血清钴迅速下降。建议每日25至50毫克剂量的肠溶氯化钴治疗在慢性肾衰竭难治性贫血的治疗中具有明确的地位。
