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Comparative Effectiveness of Iron and Erythropoiesis-Stimulating Agent Dosing on Health-Related Quality of Life in Patients Receiving Hemodialysis.
- Source :
-
American journal of kidney diseases : the official journal of the National Kidney Foundation [Am J Kidney Dis] 2016 Feb; Vol. 67 (2), pp. 271-82. Date of Electronic Publication: 2015 Oct 23. - Publication Year :
- 2016
-
Abstract
- Background: The potential effects of iron-dosing strategies and erythropoiesis-stimulating agents (ESAs) on health-related quality of life (HRQoL) in the dialysis population are unclear. We examined the independent associations of bolus versus maintenance iron dosing and high versus low ESA dosing on HRQoL.<br />Study Design: Retrospective cohort design.<br />Setting & Participants: Clinical data (2008-2010) from a large dialysis organization merged with data from the US Renal Data System. 13,039 patients receiving center-based hemodialysis were included.<br />Predictor: Iron and ESA dosing were assessed during 1-month (n=14,901) and 2-week (n=15,296) exposure periods.<br />Outcomes: HRQoL was measured by the Kidney Disease Quality of Life (KDQOL) instrument (0-100 scale) during a 3-month follow-up period.<br />Measurements: Generalized linear mixed models, adjusting for several covariates, were used to estimate associations between iron and ESA dosing and HRQoL overall and for clinically relevant subgroups.<br />Results: For the 1-month exposure period, patients with lower baseline hemoglobin levels who received higher ESA dosing had higher physical health and kidney disease symptom scores (by 2.4 [95% CI, 0.6-4.2] and 5.6 [95% CI, 2.8-8.4] points, respectively) in follow-up than patients who received lower ESA dosing. For the 2-week exposure period, patients with low baseline hemoglobin levels who received bolus dosing had higher mental health scores (by 1.9 [95% CI, 0.0-3.8] points) in follow-up. Within the low-baseline-hemoglobin subgroup, individuals with a catheter or dialysis vintage less than 1 year who received higher ESA dosing had higher HRQoL scores in follow-up (by 5.0-9.9 points) and individuals with low baseline transferrin saturations who received bolus dosing had higher HRQoL scores in follow-up (by 2.6-5.8 points).<br />Limitations: Observational design; short duration of observation.<br />Conclusions: For individuals with low baseline hemoglobin levels, higher ESA dosing and bolus iron dosing were associated with slightly higher HRQoL scores in follow-up. These differences became more pronounced and clinically relevant for specific subgroups.<br /> (Copyright © 2016 National Kidney Foundation, Inc. All rights reserved.)
- Subjects :
- Adult
Aged
Cohort Studies
Dose-Response Relationship, Drug
Erythropoiesis physiology
Female
Follow-Up Studies
Humans
Kidney Failure, Chronic diagnosis
Kidney Failure, Chronic therapy
Male
Middle Aged
Renal Dialysis methods
Retrospective Studies
Treatment Outcome
Erythropoiesis drug effects
Health Status
Hematinics administration & dosage
Iron administration & dosage
Quality of Life
Renal Dialysis adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1523-6838
- Volume :
- 67
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- American journal of kidney diseases : the official journal of the National Kidney Foundation
- Publication Type :
- Academic Journal
- Accession number :
- 26508682
- Full Text :
- https://doi.org/10.1053/j.ajkd.2015.09.011