title: Impact of erythropoiesis-stimulating agents on energy and physical function in nondialysis CKD patients with anemia: a systematic review.
abstract: 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.
  
  
  METHODS
  Systematic literature search to identify articles (1980-2008) that evaluated effects of ESAs on patient-reported energy and physical function.
  
  
  METHODS
  Nondialysis CKD patients with anemia enrolled in prospective trials.
  
  
  METHODS
  Prospective studies measuring energy or physical function with both baseline and follow-up measurement.
  
  
  METHODS
  ESA treatment.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Findings and conclusions were limited by the available evidence.
  
  
  CONCLUSIONS
  RCTs and single-arm studies indicate that treatment of anemia with ESAs improves energy and physical function in nondialysis CKD patients.
authors.affiliation: Amgen Inc, Thousand Oaks, CA, USA.
authors.forename: Shravanthi R
authors.initials: SR
authors.lastname: Gandra
authors.forename: Fredric O
authors.initials: FO
authors.lastname: Finkelstein
authors.forename: Antonia V
authors.initials: AV
authors.lastname: Bennett
authors.forename: Eldrin F
authors.initials: EF
authors.lastname: Lewis
authors.forename: Tracy
authors.initials: T
authors.lastname: Brazg
authors.forename: Mona L
authors.initials: ML
authors.lastname: Martin
mesh_terms: D000740:Anemia / Q000188:drug therapy* / Q000209:etiology*; D002908:Chronic Disease; D005221:Fatigue; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D009043:Motor Activity; D011788:Quality of Life
chemical_list: D006397:Hematinics