Intervention Review

Frequency of administration of recombinant human erythropoietin for anaemia of end-stage renal disease in dialysis patients

  1. June D Cody1,*,
  2. Conal Daly2,
  3. Marion K Campbell3,
  4. Cam Donaldson4,
  5. Izhar Khan5,
  6. Luke Vale6,
  7. Sheila A Wallace7,
  8. Alison M MacLeod5

Editorial Group: Cochrane Renal Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 24 MAY 2005

DOI: 10.1002/14651858.CD003895.pub2

Database Title

Additional Information

How to Cite

Cody JD, Daly C, Campbell MK, Donaldson C, Khan I, Vale L, Wallace SA, MacLeod AM. Frequency of administration of recombinant human erythropoietin for anaemia of end-stage renal disease in dialysis patients. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD003895. DOI: 10.1002/14651858.CD003895.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 Newcastle upon Tyne, Department of Economics, Newcastle upon Tyne, UK

  5. 5

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

  6. 6

    University of Aberdeen, Health Economics, Aberdeen, UK

  7. 7

    University of Aberdeen, Academic Urology Unit, Aberdeen, 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

The benefits of recombinant human erythropoietin (rHuEPO) administration in dialysis patients have been demonstrated, however the optimal frequency regimen have yet to be established.

Objectives

To assess the effects of different frequency regimens of rHuEPO administration in dialysis patients on anaemia correction, quality of life and optimal use.

Search methods

We searched 13 electronic databases (1980 to May 2001) the Internet (August 1997), handsearched Kidney International (1983 to May 1997), contacted known investigators, biomedical companies, and screened reference lists of relevant articles.
Most recent search: 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 different frequencies of rHuEPO administration in dialysis patients. We compared haemodialysis and CAPD patients and subcutaneous and intravenous administration.

Data collection and analysis

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

Main results

Eleven studies (719 patients) were included. There was no significant difference in maintaining target haemoglobin for once versus twice weekly administration (one study, 20 patients: RR 1.00, 95% CI 0.42 to 2.40) or mean haemoglobin after 12 weeks of therapy between haemodialysis and CAPD patients (two studies: MD -0.21 g/dL, 95% CI -0.98 to 0.56) At the end of study for once versus thrice weekly administration (three studies: SMD -0.31, 95% CI -0.67 to 0.06) and at the end of maintenance phase (one study: MD -0.2 g/dL, 95% CI -0.65 to 0.25) there was no significant difference. More rHuEPO was required by haemodialysis patients receiving once weekly versus twice weekly doses (MD 12.0 U/kg, 95% CI 0.24 to 23.76). No difference was found for CAPD patients alone or combined (MD 4.38 U/kg, 95% CI -11.28 to 20.04). Once versus thrice weekly administration was not significant (MD 10.00 U/kg, 95% CI -80.87 to 100.87). There was no difference in the frequency of adverse events.

Authors' conclusions

There is no significant difference between once weekly versus thrice weekly subcutaneous administration of rHuEPO. Once weekly administration would require an additional 12 U/kg/wk for patients on haemodialysis, however this is based on one very small study. Cost of additional rHuEPO needs to assessed with regard to patient preference and compliance.

 

Plain language summary

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

At the moment there is no evidence to support one frequency of administration of erythropoietin over another

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 or through fluid exchange through the abdomen). The review of trials found no evidence to support one frequency over another.

 

摘要

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

背景

對治療末期腎病變透析病人的貧血施打重組人類紅血球生成素的頻率

重組人類紅血球生成素在透析病人的好處已經很明確了,但是適當的頻率劑量還沒建立

目標

評估不同注射重組人類紅血球生成素的頻率在洗腎病人治療貧血,改善生活品質以及最適當的使用.

搜尋策略

我們搜尋了13個電子資料庫 (1980到2001年5月), 網際網路 (1997年8月), Kidney International (1983 to 1997年5月), 聯繫已知的研究員,生物醫學科技公司,和篩選了已發表論文的參考目錄.最近的搜尋: The Cochrane Renal Group's specialised register (June 2004年) and The Cochrane Library (Issue 3, 2004年).

選擇標準

比較在透析病人身上以不同的頻率注射重組人類紅血球生成素的隨機控制試驗和準隨機控制試驗.我們比較了血液透析和腹膜透析以及皮下和靜脈注射.

資料收集與分析

品質評估由2位審查員執行.資料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 weighted mean difference (WMD) with 95% confidence intervals (CI) 來呈現.

主要結論

11個研究719個病人被包括進來. 在維持血色素的目標值方面,以及12週的平均血紅素上,每週一次和每週二次的紅血球生成素治療在血液透析和腹膜透析的病人並沒有差別.在上面這兩個研究的結尾, 一週一次和一週三次沒有顯著的差異.在血液透析的病人身上每週一次紅血球生成素的劑量需要比一週兩次的劑量來的大. 對腹膜透析的病人而言,單獨使用跟合併使用並沒有顯著的差異.每週一次紅血球生成素的劑量跟一週三次劑量上沒有顯著的差異. 在不良事件的發生率也沒有差異.

作者結論

一週一次皮下注射紅血球生成素跟一週三次沒有任何顯著的差異. 一個小型的研究,在血液透析的病人上一週一次需要額外增加紅血球生成素 12 U/kg/wk. 額外重組人類紅血球生成素的費用,需要和病人的意願和順從性來評估.

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

目前沒有任何證據證明哪一種紅血球生成素的施打頻率是最好的. 貧血 (低紅血球) 是腎衰竭常見的併發症.貧血導致某些和腎衰竭相關的疲倦和問題。人工紅血球生成素 (一種增加紅血球生產的賀爾蒙) 可以改善這些問題,而且可以使用在透析的病人 (使用人工腎臟治療或是經由腹部做液體交換) 。試驗回顧沒有證據支持那一種頻率較好。

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