Impact of Erythropoiesis-Stimulating Agents on Energy and Physical Function in Nondialysis CKD Patients With Anemia: A Systematic Review
Received 14 April 2009; accepted 14 September 2009. published online 23 December 2009.
Refers to article:
Quality of Life in CKD Patients Treated With Erythropoiesis-Stimulating Agents
Patrick S. Parfrey, Tyler Wish
American Journal of Kidney Diseases
March 2010 (Vol. 55, Issue 3, Pages 423-425) Full Text |
Full-Text PDF (129 KB)
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.
ABSTRACT