title: The Effect of Erythropoietin-Stimulating Agents on Health-Related Quality of Life in Anemia of Chronic Kidney Disease: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  The efficacy of erythropoietin-stimulating agents (ESAs) for improving health-related quality of life (HRQOL) in anemia of chronic kidney disease (CKD) is unclear.
  
  
  OBJECTIVE
  To determine the effect of ESAs on HRQOL at different hemoglobin targets in adults with CKD who were receiving or not receiving dialysis.
  
  
  METHODS
  Searches of PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov from inception to 1 November 2015, supplemented with manual screening.
  
  
  METHODS
  Randomized, controlled trials that evaluated the treatment of anemia with ESAs, including erythropoietin and darbepoetin, targeted higher versus lower hemoglobin levels, and used validated HRQOL metrics.
  
  
  METHODS
  Study characteristics, quality, and data were assessed independently by 2 reviewers. Outcome measures were scores on the Short Form-36 Health Survey (SF-36), Kidney Dialysis Questionnaire (KDQ), and other tools.
  
  
  RESULTS
  Of 17 eligible studies, 13 reported SF-36 outcomes and 4 reported KDQ outcomes. Study populations consisted of patients not undergoing dialysis (n = 12), those undergoing dialysis (n = 4), or a mixed sample (n = 1). Only 4 studies had low risk of bias. Pooled analyses showed that higher hemoglobin targets resulted in no statistically or clinically significant differences in SF-36 or KDQ domains. Differences in HRQOL were further attenuated in studies at low risk of bias and in subgroups of dialysis recipients.
  
  
  CONCLUSIONS
  Statistically significant heterogeneity among studies, few good-quality studies, and possible publication bias.
  
  
  CONCLUSIONS
  ESA treatment of anemia to obtain higher hemoglobin targets does not result in important differences in HRQOL in patients with CKD.
  
  
  BACKGROUND
  KRESCENT and Manitoba Health Research Council Establishment.
authors.forename: David
authors.initials: D
authors.lastname: Collister
authors.forename: Paul
authors.initials: P
authors.lastname: Komenda
authors.forename: Brett
authors.initials: B
authors.lastname: Hiebert
authors.forename: Ravindi
authors.initials: R
authors.lastname: Gunasekara
authors.forename: Yang
authors.initials: Y
authors.lastname: Xu
authors.forename: Fredrick
authors.initials: F
authors.lastname: Eng
authors.forename: Blake
authors.initials: B
authors.lastname: Lerner
authors.forename: Kerry
authors.initials: K
authors.lastname: Macdonald
authors.forename: Claudio
authors.initials: C
authors.lastname: Rigatto
authors.forename: Navdeep
authors.initials: N
authors.lastname: Tangri
mesh_terms: D000740:Anemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D006397:Hematinics / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D011788:Quality of Life; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000628:therapy
chemical_list: D006397:Hematinics; D006454:Hemoglobins