David Collister, MD; Paul Komenda, MD, MHA, CHE; Brett Hiebert, MSc; Ravindi Gunasekara, BSc; Yang Xu, MD, BSc (Pharm); Frederick Eng, BSc; Blake Lerner, BSc; Kerry Macdonald, MLIS; Claudio Rigatto, MD, MSc; Navdeep Tangri, MD, PhD
Grant Support: By KRESCENT and Manitoba Health Research Council Establishment.
Reproducible Research Statement:Study protocol: See Supplement. Statistical code and data set: Available upon request to approved individuals through written agreement with the authors.
Disclosures: Dr. Komenda is on the scientific advisory board at NxStage outside the study. Dr. Tangri is on the medical advisory board at Takeda and Otsuka outside the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-1839.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Requests for Single Reprints: Navdeep Tangri, MD, PhD, Seven Oaks General Hospital Renal Program, 2300 McPhillips Street, 2PD13, Winnipeg, Manitoba R2V 3M3, Canada; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Collister, Komenda, Xu, Rigatto, and Tangri; Ms. Gunasekara; Mr. Eng and Mr. Lerner: Seven Oaks General Hospital Renal Program, 2300 McPhillips Street, 2PD13, Winnipeg, Manitoba R2V 3M3, Canada.
Mr. Hiebert: Cardiac Sciences Program, CR1038 Asper Clinical Research Building, 369 Taché Avenue, Winnipeg, Manitoba R2H 2A6, Canada.
Ms. Macdonald: St. Boniface Hospital & Research Campus, 409 Taché Avenue, Winnipeg, Manitoba R2H 2A6, Canada.
Author Contributions: Conception and design: D. Collister, P. Komenda, C. Rigatto, N. Tangri.
Analysis and interpretation of the data: D. Collister, P. Komenda, B. Hiebert, R. Gunasekara, Y. Xu, C. Rigatto, N. Tangri.
Drafting of the article: D. Collister, B. Hiebert, R. Gunasekara, C. Rigatto, N. Tangri.
Critical revision of the article for important intellectual content: D. Collister, P. Komenda, C. Rigatto, N. Tangri.
Final approval of the article: D. Collister, P. Komenda, C. Rigatto, N. Tangri.
Provision of study materials or patients: N. Tangri.
Statistical expertise: P. Komenda, B. Hiebert, N. Tangri.
Obtaining of funding: N. Tangri.
Administrative, technical, or logistic support: P. Komenda, K. Macdonald, N. Tangri.
Collection and assembly of data: D. Collister, R. Gunasekara, Y. Xu, F. Eng, B. Lerner, K. Macdonald, N. Tangri.
The efficacy of erythropoietin-stimulating agents (ESAs) for improving health-related quality of life (HRQOL) in anemia of chronic kidney disease (CKD) is unclear.
To determine the effect of ESAs on HRQOL at different hemoglobin targets in adults with CKD who were receiving or not receiving dialysis.
Searches of PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov from inception to 1 November 2015, supplemented with manual screening.
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.
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.
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.
Statistically significant heterogeneity among studies, few good-quality studies, and possible publication bias.
ESA treatment of anemia to obtain higher hemoglobin targets does not result in important differences in HRQOL in patients with CKD.
KRESCENT and Manitoba Health Research Council Establishment.
David Collister, Paul Komenda, Brett Hiebert, Ravindi Gunasekara, Yang Xu, Frederick Eng, et al. The Effect of Erythropoietin-Stimulating Agents on Health-Related Quality of Life in Anemia of Chronic Kidney Disease: A Systematic Review and Meta-analysis. Ann Intern Med. 2016;164:472–478. doi: 10.7326/M15-1839
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Published: Ann Intern Med. 2016;164(7):472-478.
Published at www.annals.org on 16 February 2016
Chronic Kidney Disease, Hematology/Oncology, Nephrology, Red Cell Disorders, Renal Replacement Therapy.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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