Early versus delayed erythropoietin for the anaemia of end-stage kidney disease

Urrútia, G.; Ariza García, A.; Martí-Carvajal, A.J.; Coronado Daza, J.; Loza Munarriz, Cesar Antonio; Páez-Canro, C.; Rodelo Ceballos, J.; Yomayusa González, N.

dc.contributor.author	Coronado Daza, J.
dc.contributor.author	Martí-Carvajal, A.J.
dc.contributor.author	Ariza García, A.
dc.contributor.author	Rodelo Ceballos, J.
dc.contributor.author	Yomayusa González, N.
dc.contributor.author	Páez-Canro, C.
dc.contributor.author	Loza Munarriz, Cesar Antonio
dc.contributor.author	Urrútia, G.
dc.date.accessioned	2019-02-22T14:56:08Z
dc.date.available	2019-02-22T14:56:08Z
dc.date.issued	2015
dc.identifier.uri	https://hdl.handle.net/20.500.12866/5834
dc.description.abstract	Background: Anaemia is a common complication in people with chronic kidney disease (CKD) and mainly develops as a consequence of relative erythropoietin (EPO) deficiency. Anaemia develops early in the course of disease and peaks among people with end-stage kidney disease (ESKD). Many types of EPO - also called erythropoiesis-stimulating agents (ESAs) - are used to treat anaemia in people with ESKD. ESAs have changed treatment of severe anaemia among people with CKD by relieving symptoms and avoiding complications associated with blood transfusion. However, no benefits have been found in relation to mortality rates and non-cardiac fatal events, except quality of life. Moreover, a relationship between ESA use and increased cardiovascular morbidity and mortality in patients with CKD has been reported in studies with fully correcting anaemia comparing with partial anaemia correction. Until 2012, guidelines recommended commencing ESA treatment when haemoglobin was less than 11 g/dL; the current recommendation is EPO commencement when haemoglobin is between 9 and 10 g/dL. However, advantages in commencing therapy when haemoglobin levels are greater than 10 g/dL but less than 11 g/dL remain unknown, especially among older people whose life expectancy is limited, but in whom EPO therapy may improve quality of life. Objectives: To assess the clinical benefits and harms of early versus delayed EPO for anaemia in patients with ESKD undergoing haemodialysis or peritoneal dialysis Search methods: We searched the Cochrane Kidney and Transplant Specialised Register to 22 May 2017 through contact with the Information Specialist using search terms relevant to this review. Selection criteria: We planned to include randomised controlled trials (RCTs) and quasi-RCTs evaluating at the clinical benefits and harms of early versus delayed EPO for anaemia in patients with ESKD undergoing haemodialysis or peritoneal dialysis. Studies comparing EPO with another EPO, placebo or no treatment were eligible for inclusion. Data collection and analysis: It was planned that two authors would independently extract data from included studies and assess risk of bias using the Cochrane risk of bias tool. For dichotomous outcomes (all-cause mortality, cardiovascular mortality, overall myocardial infarction, overall stroke, vascular access thrombosis, adverse effects of treatment, transfusion), we planned to use the risk ratio (RR) with 95% confidence intervals (CI). We planned to calculate the mean difference (MD) and CI 95% for continuous data (haemoglobin level) and the standardised mean difference (SMD) with CI 95% for quality of life if different scales had been used. Main results: Literature searches yielded 1910 records, of these 1534 were screened after duplicates removed, of which 1376 were excluded following title and abstract assessment. We assessed 158 full text records and identified 18 studies (66 records) that were potentially eligible for inclusion. However, none matched our inclusion criteria and were excluded. Authors' conclusions: We found no evidence to assess the benefits and harms of early versus delayed EPO for the anaemia of ESKD.	en_US
dc.language.iso	eng
dc.publisher	Wiley
dc.relation.ispartofseries	Cochrane Database of Systematic Reviews
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.rights.uri	https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject	Humans	en_US
dc.subject	hemoglobin	en_US
dc.subject	anemia	en_US
dc.subject	hypertension	en_US
dc.subject	mortality	en_US
dc.subject	erythropoietin	en_US
dc.subject	human	en_US
dc.subject	priority journal	en_US
dc.subject	complication	en_US
dc.subject	placebo	en_US
dc.subject	Renal Dialysis	en_US
dc.subject	deep vein thrombosis	en_US
dc.subject	thrombosis	en_US
dc.subject	Review	en_US
dc.subject	systematic review	en_US
dc.subject	Erythropoietin	en_US
dc.subject	Anemia	en_US
dc.subject	heart infarction	en_US
dc.subject	hemoglobin blood level	en_US
dc.subject	cardiovascular mortality	en_US
dc.subject	hemodialysis	en_US
dc.subject	Kidney Failure, Chronic	en_US
dc.subject	renal replacement therapy	en_US
dc.subject	brain hemorrhage	en_US
dc.subject	brain ischemia	en_US
dc.subject	erythrocyte transfusion	en_US
dc.subject	end stage renal disease	en_US
dc.subject	peritoneal dialysis	en_US
dc.subject	antianemic agent	en_US
dc.subject	dialysis vascular access thrombosis	en_US
dc.subject	Hematinics	en_US
dc.subject	peripheral arterial thrombosis	en_US
dc.title	Early versus delayed erythropoietin for the anaemia of end-stage kidney disease	en_US
dc.type	info:eu-repo/semantics/review
dc.identifier.doi	https://doi.org/10.1002/14651858.CD011122.pub2
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.01.05
dc.relation.issn	1469-493X