BACKGROUND: The efficacy of erythropoietin-stimulating agents (ESAs) for improving health-related quality of life (HRQOL) in anemia of chronic kidney disease (CKD) is unclear. PURPOSE: To determine the effect of ESAs on HRQOL at different hemoglobin targets in adults with CKD who were receiving or not receiving dialysis. DATA SOURCES: Searches of PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov from inception to 1 November 2015, supplemented with manual screening. STUDY SELECTION: Randomized, controlled trials that evaluated the treatment of anemia with ESAs, including erythropoietin and darbepoetin, targeted higher versus lower hemoglobin levels, and used validated HRQOL metrics. DATA EXTRACTION: Study characteristics, quality, and data were assessed independently by 2 reviewers. Outcome measures were scores on the Short Form-36 Health Survey (SF-36), Kidney Dialysis Questionnaire (KDQ), and other tools. DATA SYNTHESIS: Of 17 eligible studies, 13 reported SF-36 outcomes and 4 reported KDQ outcomes. Study populations consisted of patients not undergoing dialysis (n = 12), those undergoing dialysis (n = 4), or a mixed sample (n = 1). Only 4 studies had low risk of bias. Pooled analyses showed that higher hemoglobin targets resulted in no statistically or clinically significant differences in SF-36 or KDQ domains. Differences in HRQOL were further attenuated in studies at low risk of bias and in subgroups of dialysis recipients. LIMITATION: Statistically significant heterogeneity among studies, few good-quality studies, and possible publication bias. CONCLUSION: ESA treatment of anemia to obtain higher hemoglobin targets does not result in important differences in HRQOL in patients with CKD. PRIMARY FUNDING SOURCE: KRESCENT and Manitoba Health Research Council Establishment.
BACKGROUND: The efficacy of erythropoietin-stimulating agents (ESAs) for improving health-related quality of life (HRQOL) in anemia of chronic kidney disease (CKD) is unclear. PURPOSE: To determine the effect of ESAs on HRQOL at different hemoglobin targets in adults with CKD who were receiving or not receiving dialysis. DATA SOURCES: Searches of PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov from inception to 1 November 2015, supplemented with manual screening. STUDY SELECTION: Randomized, controlled trials that evaluated the treatment of anemia with ESAs, including erythropoietin and darbepoetin, targeted higher versus lower hemoglobin levels, and used validated HRQOL metrics. DATA EXTRACTION: Study characteristics, quality, and data were assessed independently by 2 reviewers. Outcome measures were scores on the Short Form-36 Health Survey (SF-36), Kidney Dialysis Questionnaire (KDQ), and other tools. DATA SYNTHESIS: Of 17 eligible studies, 13 reported SF-36 outcomes and 4 reported KDQ outcomes. Study populations consisted of patients not undergoing dialysis (n = 12), those undergoing dialysis (n = 4), or a mixed sample (n = 1). Only 4 studies had low risk of bias. Pooled analyses showed that higher hemoglobin targets resulted in no statistically or clinically significant differences in SF-36 or KDQ domains. Differences in HRQOL were further attenuated in studies at low risk of bias and in subgroups of dialysis recipients. LIMITATION: Statistically significant heterogeneity among studies, few good-quality studies, and possible publication bias. CONCLUSION: ESA treatment of anemia to obtain higher hemoglobin targets does not result in important differences in HRQOL in patients with CKD. PRIMARY FUNDING SOURCE: KRESCENT and Manitoba Health Research Council Establishment.
Authors: David T Selewski; Aliza Thompson; Sarrit Kovacs; Elektra J Papadopoulos; Noelle E Carlozzi; Howard Trachtman; Jonathan P Troost; Peter A Merkel; Debbie S Gipson Journal: Clin J Am Soc Nephrol Date: 2016-06-03 Impact factor: 8.237
Authors: Emma L O'Lone; Elisabeth M Hodson; Ionut Nistor; Davide Bolignano; Angela C Webster; Jonathan C Craig Journal: Cochrane Database Syst Rev Date: 2019-02-21
Authors: Federica Picariello; Rona Moss-Morris; Iain C Macdougall; Sam Norton; Maria Da Silva-Gane; Ken Farrington; Hope Clayton; Joseph Chilcot Journal: BMJ Open Date: 2018-03-08 Impact factor: 2.692
Authors: Joann Carlson; Arlene C Gerson; Matthew B Matheson; Sharon Manne; Bradley A Warady; Stephen R Hooper; Marc Lande; Lyndsay A Harshman; Rebecca J Johnson; Shlomo Shinnar; Amy J Kogon; Susan Furth Journal: Pediatr Nephrol Date: 2020-04-24 Impact factor: 3.714