Intervention Review

Recombinant human erythropoietin for chronic renal failure anaemia in pre-dialysis patients

  1. June D Cody1,*,
  2. Conal Daly2,
  3. Marion K Campbell3,
  4. Izhar Khan4,
  5. Kannaiyan S Rabindranath5,
  6. Luke Vale6,
  7. Sheila A Wallace7,
  8. Alison M MacLeod4,
  9. Adrian Grant8,
  10. Susan Pennington9

Editorial Group: Cochrane Renal Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 24 MAY 2005

DOI: 10.1002/14651858.CD003266.pub2

Database Title

Additional Information

How to Cite

Cody JD, Daly C, Campbell MK, Khan I, Rabindranath KS, Vale L, Wallace SA, MacLeod AM, Grant A, Pennington S. Recombinant human erythropoietin for chronic renal failure anaemia in pre-dialysis patients. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD003266. DOI: 10.1002/14651858.CD003266.pub2.

Author Information

  1. 1

    University of Aberdeen, Cochrane Incontinence Review Group, Foresterhill, Aberdeen, UK

  2. 2

    Western Infirmary Glasgow, Renal Unit, Glasgow, Scotland, UK

  3. 3

    University of Aberdeen, Health Services Research Unit, Aberdeen, Scotland, UK

  4. 4

    University of Aberdeen, Department of Medicine and Therapeutics, Aberdeen, UK

  5. 5

    Churchill Hospital, Renal Unit, Oxford, UK

  6. 6

    University of Aberdeen, Health Economics, Aberdeen, UK

  7. 7

    University of Aberdeen, Academic Urology Unit, Aberdeen, Scotland, UK

  8. 8

    University of Aberdeen, School of Medicine, Aberdeen, Scotland, UK

  9. 9

    Braehead, Balnagowan, Dundee, Scotland, UK

*June D Cody, Cochrane Incontinence Review Group, University of Aberdeen, 1st Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK. j.cody@abdn.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Treatment with recombinant human erythropoietin (rHu EPO) in dialysis patients has been shown to be highly effective in terms of correcting anaemia and improving quality of life. There is debate concerning the benefits of rHu EPO use in pre-dialysis patients which may accelerate the deterioration of renal function. However the opposing view is that if rHu EPO is as effective in pre-dialysis patient's, improving the patients sense of well-being may result in the onset of dialysis being delayed.

Objectives

To assess the effects of rHu EPO use in pre-dialysis patients with renal anaemia.

Search methods

The initial search included 13 electronic databases (1980 to May 2001) an Internet search (August 1997), handsearching of Kidney International (1983 to May 1997), contact with known investigators and biomedical companies, and reference list of relevant articles. For this update we searched the Cochrane Renal Group's specialised register (June 2004) and The Cochrane Library (Issue 3, 2004).

Selection criteria

Randomised controlled trials (RCTs) or quasi-RCTs comparing the use of rHu EPO with no treatment or placebo in pre-dialysis patients.

Data collection and analysis

Only published data were used. Quality assessment was performed by two assessors independently. Data were abstracted by a single author onto a standard form, a sample of which was checked by another author. Results were expressed as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI).

Main results

Fifteen trials (461 participants) were included. There was a marked improvement in haemoglobin (MD 1.82 g/dL, 95% CI 1.35 to 2.28) and haematocrit (MD 9.85%, 95% CI 8.35 to 11.34) with treatment and a decrease in the number of patients requiring blood transfusions (RR 0.32, 95% CI 0.12 to 0.83). The data from studies reporting quality of life or exercise capacity demonstrated an improvement in the treatment group. Most of the measures of progression of renal disease showed no statistically significant difference. No significant increase in adverse events was identified.

Authors' conclusions

Treatment with rHu EPO in pre-dialysis patients corrects anaemia, avoids the requirement for blood transfusions and also improves quality of life and exercise capacity. We were unable to assess the effects of rHu EPO on progression of renal disease, delay in the onset of dialysis or adverse events. Based on the current evidence, decisions on the putative benefits in terms of quality of life are worth the extra costs of pre-dialysis rHu EPO need careful evaluation.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Erythropoietin may help people with kidney failure and symptoms from anaemia who are not yet on dialysis.

Anaemia (low red blood cells) is a common complication of kidney failure. Anaemia causes some of the tiredness and problems associated with kidney failure. Manufactured erythropoietin (a hormone that increases red blood cell production) improves this, and is used by people on dialysis (treatment from an artificial kidney machine). The review of trials found it can also reduce anaemia for people with kidney failure who are not yet on dialysis. It is not known if erythropoietin use can delay the need for dialysis.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

在接近透析患者使用紅血球生成素治療慢性腎衰竭的貧血

用紅血球生成素治療透析病人對於貧血和改善生活品質非常有效. 有些爭論關於在接近透析患者使用紅血球生成素也許會加速腎臟功能的惡化。然而反對的看法是如果在將近透析患者的紅血球生成素是有效的,改進患者健康感覺,也許可以晚一點透析。

目標

評估紅血球生成素治療將近透析患者的貧血

搜尋策略

一開始的搜尋包括了13個電子資料庫 (1980到2001年5月), 1個網際網路搜尋 (1997年8月), 搜尋Kidney International (1983到1997年5月), 聯繫已知的研究者和生物醫學公司,以及相關文章的參考目錄.為了這次更新, 我們搜尋了Cochrane Renal Group's specialised register (2004年7月) and The Cochrane Library (Issue 3, 2004年).

選擇標準

比較在將近透析的病人身上使用紅血球生成素和沒有治療或是安慰劑的隨機控制試驗或是準隨機控制試驗

資料收集與分析

只有發表過的數據才使用.有兩位評估委員獨立的做品質的評估.數據由在一種標準格式上的一位作者提出，樣品由另一位作者檢查。結果以 relative risk (RR) 或是 weighted mean difference (WMD) with 95% confidence intervals (CI) 呈現.

主要結論

15個研究461個病人被包括進來.血色素 (WMD 1.82 g/dL, 95% CI 1.35to 2.28) 和血比容 (WMD 9.85%, 95% CI 8.35 to 11.34) 在治療後都有明顯改善而且減少了病人需要輸血的數目 (RR 0.32, 95% CI 0.12 to 0.83). 這些研究很明顯的顯示治療組改善了生活品質和活動能力.絕大部分的腎臟病惡化的速度沒有顯著性的差異.不良事件的發生並無明顯的增加

作者結論

用紅血球生成素治療將近透析患者的貧血,改善生活品質和活動能力以及避免輸血. 我們無法確定紅血球生成素在腎臟功能的惡化,延遲透析時間或是避免不好的副作用的影響.基於目前的證據,是否值得使用額外紅血球生成素的花費,來達到改善將近透析病人的生活品質和活動能力需要審慎的評估.

翻譯人

本摘要由馬偕醫院劉千義翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

紅血球生成素可能幫忙腎衰竭和有貧血症狀的將近透析病人.貧血 (低紅血球數) 是一個腎衰竭常見的併發症.貧血造成了一些跟腎衰竭相關的疲倦和症狀. 人工合成的紅血球生成素 (會增加紅血球生成的一種賀爾蒙) 改善這些狀況,而且使用在透析的病人身上 (使用人工腎臟治療). 這些試驗的回顧也發現它也能減少腎衰竭尚未透析病人的貧血.目前還不清楚紅血球生成素的使用能不能延緩透析治療.

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