Posted on Sunday, 29th March 2009 by admin
November 14, 2008 — Preventing anemia may improve quality of life (QofL) in patients with kidney disease, according to the results of a cross-sectional study published online November 5, 2008, in the Clinical Journal of the American Society of Nephrology.
“The relationship between [QofL] and anemia has been the subject of recent debates,” write Fredric O. Finkelstein, MD, from the Hospital of St. Raphael, Yale University, in New Haven, Connecticut, and colleagues. “It has been suggested that the QofL changes associated with the treatment of anemia of chronic kidney disease (CKD) or [end-stage renal disease] patients should not be used in making decisions to treat anemia in CKD patients.”
The objective of the CKD RenalSoft Informatics Observational Study was to examine the relationship between anemia severity and health-related QofL in a cohort of patients with CKD (stages 3 – 5, not on dialysis) followed in 7 centers. Of 1200 patients enrolled in the study, 1186 completed the Kidney Disease QofL (KDQofL) questionnaire. These data were correlated with contemporaneous hemoglobin (Hgb) levels.
In a stepwise fashion, QofL measures were compared for hemoglobin levels of less than 11, 11 to less than 12, 12 to less than 13, and more than 13. Analysis of variance was used to evaluate associations between QofL scores and Hgb level, age, CKD stage, and albumin level; history of diabetes, congestive heart failure, or myocardial infarction; use of erythropoetic-stimulating agents (ESAs); and the interaction of Hgb level and ESA use.
Increasing Hgb levels were associated with a statistically significant increase in all 4 physical domains of the KDQofL questionnaire, the energy/vitality domain, the physical composite score of the SF-36, and the general health score on the kidney disease component of the questionnaire.
“The most dramatic improvements in these various domains occurred between the <11 and the 11 to 12 group,” the study authors write. “Higher Hgb levels are associated with improved QofL domains of the KDQofL questionnaire. These findings have implications for the care of CKD patients in terms of the initiation of and the Hgb target of ESA therapy.”
Study limitations include nonrandomized design, unselected cohort from 7 selective centers, limited generalizability, only half of eligible patients were included, and only those covariates that were available were used in the statistical analyses.
The study authors note that current approved US Food and Drug Administration claims for the use of ESAs do not reflect the QofL changes demonstrated in this study, and they therefore recommend additional prospective studies to systematically document the changes in health-related QofL domains associated with ESA use in CKD patients.
The authors have disclosed no relevant financial relationships.
Clin J Am Soc Nephrol. Published online November 5, 2008.
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