The Effect of Erythropoietin-Stimulating Agents on Health-Related Quality of Life in Anemia of Chronic Kidney Disease

Collister, David; Komenda, Paul; Hiebert, Brett; Gunasekara, Ravindi; Xu, Yang; Eng, Frederick; Lerner, Blake; Macdonald, Kerry; Rigatto, Claudio; Tangri, Navdeep

doi:10.7326/m15-1839

Cited by 76 publications

(53 citation statements)

References 46 publications

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“…Although ESA administration is common practice in advanced CKD, the debate continues on target Hb and the effect on quality of life, which is likely higher for those with lower Hb levels. 363 Patients with advanced CKD (eGFR < 30 mL/min/1.73 m 2 ) should be managed in concert with nephrologists, especially when hemodialysis is contemplated. In those cases, as well as in some hemato-oncologic conditions, ESA therapy might be an option.…”

Section: Erythropoiesis-stimulating Agentsmentioning

confidence: 99%

2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure

Ezekowitz

O’Meara

McDonald

et al. 2017

Canadian Journal of Cardiology

554

496

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Since the inception of the Canadian Cardiovascular Society heart failure (HF) guidelines in 2006, much has changed in the care for patients with HF. Over the past decade, the HF Guidelines Committee has published regular updates. However, because of the major changes that have occurred, the Guidelines Committee believes that a comprehensive reassessment of the HF management recommendations is presently needed, with a view to producing a full and complete set of updated guidelines. The primary and secondary Canadian Cardiovascular Society HF panel members as well as external experts have reviewed clinically relevant literature to provide guidance for the practicing clinician. The 2017 HF guidelines provide updated guidance on the diagnosis and management (self-care, pharmacologic, nonpharmacologic, device, and referral) that should aid in day-to-day decisions for caring for patients with HF. Among specific issues covered are risk scores, the differences in management for HF with preserved vs reduced ejection fraction, exercise and rehabilitation, implantable devices, revascularization, right ventricular dysfunction, anemia, and iron deficiency, cardiorenal syndrome, sleep apnea, cardiomyopathies, HF in pregnancy, cardio-oncology, and myocarditis. We devoted attention to strategies and treatments to prevent HF, to the organization of HF care, comorbidity management, as well as practical issues around the timing of referral and follow-up care. Recognition and treatment of advanced HF is another important aspect of this update, including how to select advanced therapies as well as end of life considerations. Finally, we acknowledge the remaining gaps in evidence that need to be filled by future research.

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Section: Erythropoiesis-stimulating Agentsmentioning

confidence: 99%

2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure

Ezekowitz

O’Meara

McDonald

et al. 2017

Canadian Journal of Cardiology

554

496

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“…We considered the increasing number of missing values and dropouts as an important reason for bias and therefore determined point estimators with classification of missing values as MCAR and dropouts as MAR (see statistic section for details). Erythropoietin, which was administered to all study patients, does not seem to have a significant impact on QoL parameters according to a recent meta-analysis [50]. For a better reflection of age as an important predictor of death from a comorbid condition, the age-adjusted CCI was applied.…”

Section: Discussionmentioning

confidence: 99%

Morbidity, mortality and quality of life in the ageing haemodialysis population: results from the ELDERLY study

Seckinger

Dschietzig²,

Leimenstoll³

et al. 2016

Clin Kidney J

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BackgroundThe physical–functional and social–emotional health as well as survival of the elderly (≥75 years of age) haemodialysis patient is commonly thought to be poor. In a prospective, multicentre, non-interventional, observational study, the morbidity, mortality and quality of life (QoL) in this patient group were examined and compared with a younger cohort.MethodsIn 92 German dialysis centres, 2507 prevalent patients 19–98 years of age on haemodialysis for a median of 19.2 months were included in a drug monitoring study of darbepoetin alfa. To examine outcome and QoL parameters, 24 months of follow-up data in the age cohorts <75 and ≥75 years were analysed. Treatment parameters, adverse and intercurrent events, hospitalizations, morbidity and mortality were assessed. QoL was evaluated by means of the 47-item Functional Assessment of Chronic Illness Therapy–Anaemia score (FACT-An, version 4).ResultsThe 2-year mortality rate was 34.7% for the older cohort and 15.8% for the younger cohort. The mortality rate for the haemodialysed elderly patients was 6.2% higher in absolute value compared with the age-matched background population. A powerful predictor of survival was the baseline FACT-An score and a close correlation with the 20-item anaemia subscale (AnS) was demonstrated. While the social QoL in the elderly patients was more stable than in the younger cohort (leading to equivalent values at the end of the study period), a pronounced deterioration of physical and functional status was observed. The median number of all-cause hospital days per patient-year was 12.3 for the elderly cohort and 8.9 for the younger patient population. The overall 24-month hospitalization rate was only marginally higher in the elderly cohort (34.0 versus 33.3%).ConclusionsIn this observational study, the mortality rate of elderly haemodialysis patients was not exceedingly high compared with the age-matched background population. Furthermore, the hospitalization rate was only slightly higher compared with the younger age group and the median yearly hospitalization time trended lower compared with registry data. The social well-being of elderly haemodialysis patients showed a less pronounced decline over time and was equal to the score of the younger cohort at the end of the study period. The physical and functional status in the elderly patients was lower and showed a sharper decline over time. The baseline FACT-An score correlated closely with the 24-month survival probability.

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“…Surprisingly, a large, double-blind study of patients with NDD CKD, type 2 diabetes mellitus, and anemia showed only modest improvements in scores from the Functional Assessment of Cancer Therapy-Fatigue instrument, and no improved scores for the 36-Item Short-Form General Health Survey (SF-36) questionnaire, when patients received treatment for their anemia [46]. Additionally, a recent systematic review and meta-analysis concluded that there were no statistically or clinically significant differences between higher and lower Hb targets for HRQoL measured by SF-36 and Kidney Dialysis Questionnaire [47]. However, inherent to its focus on Hb target levels and specific HRQoL measures, potentially relevant studies were not considered due to the inability to combine results within a meta-analysis framework.…”

Section: Discussionmentioning

confidence: 99%

Impact of chronic kidney disease and anemia on health-related quality of life and work productivity: Analysis of multinational real-world data

Haalen

Jackson²,

Spinowitz

et al. 2020

Preprint

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Background Reductions in health-related quality of life (HRQoL) in patients with chronic kidney disease (CKD) are thought to be exacerbated by the low hemoglobin (Hb) levels that define anemia, a common complication of CKD. The current analysis evaluated the impact of anemia on HRQoL and work productivity in patients with non-dialysis dependent and dialysis-dependent CKD using realworld data. Methods Data were collected in France, Germany, Italy, Spain, the UK, the USA and China in 2012-2018 in the Adelphi Real World Disease Specific Programme™ for CKD, a large, crosssectional, survey of physicians and their patients. Patients completed three patient-reported outcomes (PRO) instruments: the EuroQol 5-Dimension 3-level (EQ-5D-3L), the Kidney Disease Quality of Life (KDQOL-36) instrument and the Work Productivity and Activity Impairment questionnaire. PROs were assessed by CKD stage and Hb levels, and regression analyses were performed with CKD stage and Hb level as independent variables and PROs as outcome variables, while adjusting for age, sex, CKD stage, comorbidities and cardiovascular risk. Results Overall, 5276 patients participated in the survey, including 28% stage 4 and 36% dialysis patients. Patients with lower Hb levels more often reported problems/issues on all EQ-5D-3L domains (p<0.0001). Regression analyses showed significant associations between lower Hb levels and the probability of low (<0.8) EQ-5D-3L utility scores (p<0.0001) and low visual analog scale scores (p<0.05), indicating poorer health status.Associations were seen even when adjusting for CKD stage and other potential confounding factors.Significant associations were observed between Hb level and the 12-Item Short-Form Health Survey (SF-12) Physical Component Summary, SF-12 Mental Component Summary and the three KDQOL-36 subscales (all p<0.0001), and were confirmed using linear regression analyses adjusting for CKD stage and other potential confounders. Numerically greater work productivity losses and greater activity impairment were observed with lower Hb levels. Conclusions Lower Hb levels worsen the impact of CKD on HRQoL, and are associated with lower work productivity in patients with CKD.Assessment and treatment of anemia should be recognized as a key component of integral CKD management throughout all stages of the disease.

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The Effect of Erythropoietin-Stimulating Agents on Health-Related Quality of Life in Anemia of Chronic Kidney Disease

Abstract: KRESCENT and Manitoba Health Research Council Establishment.

Cited by 76 publications

References 46 publications

2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure

2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure

Morbidity, mortality and quality of life in the ageing haemodialysis population: results from the ELDERLY study

Impact of chronic kidney disease and anemia on health-related quality of life and work productivity: Analysis of multinational real-world data

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