0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

The Effect of Erythropoietin-Stimulating Agents on Health-Related Quality of Life in Anemia of Chronic Kidney Disease: A Systematic Review and Meta-analysisErythropoietin-Stimulating Agents in Anemia of Chronic Kidney Disease

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; and Navdeep Tangri, MD, PhD
[+] Article, Author, and Disclosure Information

This article was published at www.annals.org on 16 February 2016.


From the University of Manitoba and Seven Oaks General Hospital Renal Program, Winnipeg, Manitoba, Canada.

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, ntangri@sogh.mb.ca.

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.


Ann Intern Med. 2016;164(7):472-478. doi:10.7326/M15-1839
© 2016 American College of Physicians
Text Size: A A A

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.

Figures

Grahic Jump Location
Appendix Figure 1.

Summary of evidence search and selection.

Performed 1 November 2015.

Grahic Jump Location
Grahic Jump Location
Appendix Figure 2.

Risk-of-bias assessment of included studies.

USREPSG = U.S. Recombinant Human Erythropoietin Predialysis Study Group.

Grahic Jump Location
Grahic Jump Location
Figure 1.

Forest plot of all reported data on SF-36 domains.

SF-36 = Short Form-36 Health Survey.

Grahic Jump Location
Grahic Jump Location
Figure 2.

Forest plot of all reported data on KDQ domains.

KDQ = Kidney Disease Questionnaire.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)