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Том 2 №3 2000 год - Нефрология и диализ

Сердечно-сосудистые последствия почечной анемии и терапия эритропоэтином


Кай-Уве Екард

Аннотация: История болезни 1 Больной 37 лет. В возрасте 30 лет впервые была диагностирована хроническая почечная недостаточность (ХПН). Биопсия почки не производилась. 7 лет спустя развилась терминальная ХПН (ТХПН), и был начат программный гемодиализ (ГД) в режиме 3 раза в неделю. До начала ГД имела место умеренная артериальная гипертония. После начала диализной терапии она уменьшилась и далее хорошо контролировалась малыми дозами метопролола. Гемоглобин крови (Нb) к началу ГД составлял 7-7,5 г/дл, в связи с чем через 4 мес. после начала диализа была начата терапия рекомбинантным эритропоэтином (Эпо). В результате уровень Нb быстро повысился до 10 г/дл и затем постепенно нормализовался. Доза Эпо составляет в настоящее время 6000 МЕ в неделю. Пациент часто путешествует, получая ГД в других диализных центрах. Во время путешествий Эпо-терапия, как правило, прерывается, ибо, по мнению большинства врачей этих центров, целевой Нb должен быть более низким. Как следствие, уровень Нb у пациента значительно и необычным образом варьирует. Сам пациент отмечает, что при снижении Нb ниже 12 г/дл его трудоспособность и физическая активность снижаются, становясь субоптимальными. Тем не менее, он вполне трудоспособен, и будучи кандидатом наук и занимаясь интеллектуальной деятельностью, работает полный рабочий день. Ангинозные приступы и одышка его не беспокоят. По данным эхокардиограммы, выполненной через 7 лет после начала ГД, размеры левого желудочка, толщина перегородки и задней стенки левого желудочка не изменены, дисфункция миокарда отсутствует. ** Публикуется по согласованию с автором и с разрешения Oxford University Press. ** Перевод Н.А. Томилиной, А.С. Бирюковой

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Ключевые слова: анемия, кардиальная ишемия, уремическая кардиомиопатия, эритропоэтин

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