Abstract des Autors

Human EPO was first purified in 1977. In 1979 a radioimmunoassay for EPO was developed. Shortly thereafter recombinant human erythropoietin (rHu-EPO) was synthesized. Because the kidney is the primary source of EPO, renal failure (RF) results in a severe hypoproliferative anemia. The use of rHu-EPO in RF was obvious. After rHu-EPO was found to be non-toxic in animals, it was tested in humans with RF. After the original reports by Winearls and Esbach, other centers reported on the effects of rHu-EPO. All reports agreed that rHu-EPO is effective in correcting the anemia of RF. Until CES, there had been no double-blind, placebo controlled trial assessing the effect of rHu-EPO on the quality of life and exercise capacity of anemic hemodialysis patients. Our study revealed that rHu-EPO caused a clinically and statistically significant improvement in physical symptoms and exercise tolerance. Adverse effects were minimal. Of note, there was a rise in platelet count averaging 25 x 109/L. Some interesting parallels can be drawn between anemic renal patients and "anemic" athletes. Even though athletes may have normal amounts of rbc's, their increased plasma volume lowers the concentration of those cells and they appear to be "anemic". RF patients are anemic and have an expanded plasma volume secondary to their anemia. Maximal oxygen uptake (VO2max) has been measured in such patients before and after rHu-EPO, and it increases 44% after therapy. VO2-max has also been measured in RF patients before and after training. A significant increase in VO2-max uptake was found, but the mechanism by which this was achieved can differ. Some patients behave like patients treated with rHu-EPO and increase total body arterio-venous oxygen difference because of higher arterial oxygen content achieved by increased hemoglobin levels; other patients increase total body arterio-venous oxygen difference by means of a decreased mixed venous oxygen content with no increase in hemoglobin content. One can only speculate on the response of an athlete to rHu-EPO. Verf.-Referat