Impact of Erythropoiesis-Stimulating Agents on Energy and Physical Function in Nondialysis CKD Patients With Anemia: A Systematic Review

被引:52
作者
Gandra, Shravanthi R. [1 ]
Finkelstein, Fredric O. [2 ]
Bennett, Antonia V. [3 ]
Lewis, Eldrin F. [4 ]
Brazg, Tracy [3 ]
Martin, Mona L. [3 ]
机构
[1] Amgen Inc, Thousand Oaks, CA 91320 USA
[2] Yale Univ, Hosp St Raphael, New Haven, CT USA
[3] Hlth Res Associates, Seattle, WA USA
[4] Brigham & Womens Hosp, Dept Med, Div Cardiovasc, Boston, MA 02115 USA
关键词
Nondialysis; chronic kidney disease; erythropoiesis-stimulating agents; energy; physical function; anemia; QUALITY-OF-LIFE; CHRONIC KIDNEY-DISEASE; RECOMBINANT-HUMAN-ERYTHROPOIETIN; EPOETIN-ALPHA; HEMOGLOBIN LEVEL; HEALTH; THERAPY; CANCER; NORMALIZATION; IMPROVEMENTS;
D O I
10.1053/j.ajkd.2009.09.019
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background: Previous analyses report the impact of erythropoiesis-stimulating agents (ESAs) on health-related quality of life across various populations. In this analysis, we review published studies and quantify the effect of ESA therapy on energy/fatigue and physical function in nondialysis patients with chronic kidney disease (CKD) related anemia. Study Design: Systematic literature search to identify articles (1980-2008) that evaluated effects of ESAs on patient-reported energy and physical function. Setting & Population: Nondialysis CKD patients with anemia enrolled in prospective trials. Selection Criteria for Studies: Prospective studies measuring energy or physical function with both baseline and follow-up measurement. Intervention: ESA treatment. Outcomes: Improvements in energy and physical function assessed using effect size, a measure of treatment responsiveness. Results: 14 studies were identified: 11 measured energy and 14 measured physical function. The 36-Item Short-Form Health Survey (SF-36) was the most common instrument used to report energy and physical function. Of 11 studies measuring energy, 2 were double-blind randomized placebo-controlled trials (RCTs), 5 were open-label RCTs, and 4 were single-arm open-label studies. Eight of 11 studies reported statistically significant improvements in energy. Effect size for energy ranged from small (0.24) to large (1.90) in ESA-treated groups and was moderate in each arm of the low-versus high-hemoglobin target RCTs. Of 14 studies measuring physical function, 2 were double-blind RCTs, 6 were open-label RCTs, and 6 were single-arm open-label studies. Ten of 14 studies reported statistically significant improvements in physical function. Effect size for physical function ranged from small (0.37) to large (2.38) in ESA-treated groups and was negligible to moderate in each arm of low-versus high-hemoglobin target studies. Limitations: Findings and conclusions were limited by the available evidence. Conclusion: RCTs and single-arm studies indicate that treatment of anemia with ESAs improves energy and physical function in nondialysis CKD patients. Am J Kidney Dis 55: 519-534. (C) 2010 by the National Kidney Foundation, Inc.
引用
收藏
页码:519 / 534
页数:16
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