Erythropoietin Therapy, Hemoglobin Targets, and Quality of Life in Healthy Hemodialysis Patients

Abstract

Background and objectives: The effects of different hemoglobin targets when using erythropoiesis-stimulating agents on quality of life are somewhat controversial, and predictors of change in quality of life in endstage renal disease have not been well characterized.Design, setting, participants, & measurements: Five hundred ninety-six incident hemodialysis patients without symptomatic cardiac disease were randomly assigned to hemoglobin targets of 9.5 to 11.5 g/dl or 13.5 to 14.5 g/dl for 96 weeks, using epoetin_alfa as primary therapy. Patients and attending physicians were masked to treatment assignment. Quality of life, a secondary outcome, was prospectively recorded using the Kidney Disease Quality of Life (KDQoL) questionnaire at weeks 0, 24, 36, 48, 60, 72, 84, and 96, with prespecified outcomes being fatigue and quality of social interaction.Results: The mean age and prior duration of dialysis therapy of the study population were 50.8 and 0.8 yr. Mortality was low, reflecting the relatively healthy group enrolled. Of 20 domains within the KDQoL only the prespecified domain of fatigue showed significant change over time between the two groups. Improvement in fatigue scores in the high-target group ranged from 3.2 to 7.9 over time (P ‫؍‬ 0.007) compared with change in the low-target group. Higher body mass index and lower erythropoietin dose at baseline were independent predictors of improvement in multiple KDQoL domains.Conclusions: In relatively healthy hemodialysis patients, normal hemoglobin targets may have beneficial effects on fatigue. Improvement in multiple domains of quality of life is associated with higher body mass index and lower erythropoietin requirements.

2009

“…Study size (N) is indicated by the bars on the left (15). changes with rHuEPOs (for a more detailed account see references [17,18]). By the early part of this new millennium, at a stage that in retrospect will be seen to be a "high Hb mark" for rHuEPOs, there were calls from guidelines groups (19) for more complete correction (which becomes, with each 1 g/dl of attempted correction, noticeably more expensive and more difficult to achieve).…”

The HIF System Response to ESA Therapy in CKD‐Anemia

“…The use of ESA has beneficial effects by correcting anemia and their associated symptoms and improving patients' quality of life [50,51]. However, the effects of ESA on the progression of renal function are controversial.…”

Use of agents stimulating erythropoiesis in digestive diseases

“…Some studies have suggested the possible relationship between the variability of the hemoglobin level and the patient [138,139] . Although there is variability in the results of different studies [120,131,[140][141][142][143] , the most consistent observation is that there are better results in terms of quality of life, with no increase in adverse reactions of hemoglobin in the range of 11-12 g/dL (hematocrit 33%) compared with lower levels [139][140][141][142][143][144] . There is a large study under way in relation to the normalization of hemoglobin.…”

“…Data from recent studies in CKD patients indicate increased morbidity and mortality in relation to high levels of hemoglobin (normal) [130][131][132][133] , as in patients with cancer [103,104] . It seems appropriate to establish a target hemoglobin level of 11-12 g/dL, which demonstrates greater benefit in quality of life and costeffectiveness in renal patients [120,133,[139][140][141][142][143][144][145] .…”