Economic and quality of life burden of anemia on patients with CKD on dialysis: a systematic review

Abstract

Aims:The overall cost and health-related quality of life (HRQoL) associated with current treatments for chronic kidney disease (CKD)-related anemia are not well characterized. A systematic literature review (SLR) was conducted on the costs and HRQoL associated with current treatments for CKD-related anemia among dialysis-dependent (DD) patients. Materials and methods: The authors searched the Cochrane Library, MEDLINE, EMBASE, NHS EED, and NHS HTA for English-language publications. Original studies published between January 1, 2000 and March 17, 2017 meeting the following criteria were included: adult population; study focus was CKD-related anemia; included results on patients receiving iron supplementation, red blood cell transfusion, or erythropoiesis stimulating agents (ESAs); reported results on HRQoL and/or costs. Studies which included patients with DD-CKD, did not directly compare different treatments, and had designs relevant to the objective were retained. HRQoL and cost outcomes, including healthcare resource utilization (HRU), were extracted and summarized in a narrative synthesis. Results: A total of 1,625 publications were retrieved, 15 of which met all inclusion criteria. All identified studies included ESAs as a treatment of interest. Two randomized controlled trials reported that ESA treatment improves HRQoL relative to placebo. Across eight studies comparing HRQoL of patients achieving high vs low hemoglobin (Hb) targets, aiming for higher Hb targets with ESAs generally led to modest HRQoL improvements. Two studies reported that ESA-treated patients had lower costs and HRU compared to untreated patients. One study found that aiming for higher vs lower Hb targets led to reduced HRU, while two other reported that this led to a reduction in cost-effectiveness. Limitations: Heterogeneity of study designs and outcomes; a meta-analysis could not be performed. Conclusions: ESA-treated patients undergoing dialysis incurred lower costs, lower HRU, and had better HRQoL relative to ESA-untreated patients. However, treatment to higher Hb targets led to modest HRQoL improvements compared to lower Hb targets.

Roxadustat in treating anemia in dialysis patients (ROAD): protocol and rationale of a multicenter prospective observational cohort study

“…Anemia is a common complication in patients with chronic kidney disease, especially in those on dialysis. Treatment of renal anemia is associated with improvement in cardiovascular function, and health related quality of life, reducing requirements for blood transfusion and hospitalization [18][19][20]. Erythropoiesis-stimulating agents are one of main treatments for anemia in dialysis [21].…”

Living well with kidney disease by patient and care‐partner empowerment: Kidney health for everyone everywhere

“…World Kidney Day 2021 would like to promote to the policy makers on increasing focus and resources on both drug and nondrug programmes in improving patient wellness. Examples include funding for erythropoiesis‐stimulating agents and antipruritic agents for managing anaemia and itchiness, respectively, just to name a few (Spinowitz et al, 2019; Sukul et al, 2019). Home dialysis therapies have been consistently found to improve patient autonomy and flexibility, quality of life in a cost‐effective manner, enhancing life participation.…”

Living well with kidney disease by patient and care‐partner empowerment: kidney health for everyone everywhere

“…World Kidney Day 2021 would like to promote to policy makers on increasing focus and resources on both drug and non‐drug programmes in improving patient wellness. Examples include funding for erythropoiesis‐stimulating agents and anti‐pruritic agents for managing anaemia and itchiness, respectively, just to name but a few 15,16 . Home dialysis therapies have been consistently found to improve patient autonomy and flexibility, quality of life in a cost‐effective manner and enhancing life participation.…”