Recombinant human erythropoietin and the quality of life of end-stage renal disease patients: a comparative analysis.

The clinical and quality of life outcomes of hemodialysis patients improve remarkably following treatment with recombinant human erythropoietin (Epo). However, few studies have compared the quality of life of Epo patients with that of end-stage renal disease (ESRD) patients on various treatment modalities. Data obtained in three separate studies of ESRD patients were comparatively analyzed. Over 1,500 patients from 23 dialysis and transplant centers were studied. Both objective and subjective quality of life were examined. Objective quality of life indicators included employment status, functional ability, and health status. Subjective quality of life indicators included well-being, life satisfaction, psychological affect, and happiness. Quality of life varied significantly across treatment modality, with transplant recipients generally reporting the highest levels of objective and subjective quality of life. However, hemodialysis patients treated with Epo reported a statistically significant improvement between baseline and 10 months' follow-up on all quality of life indicators, except employment. Epo patients reported a level of overall life satisfaction that exceeded that of patients on all ESRD treatment modalities. Among transplant recipients, diabetics reported the poorest quality of life, while patients on conventional immunosuppressive therapy often had a quality of life that exceeded that of patients on cyclosporine therapy. Some of these findings may be explained by case-mix differences, as well as differing study designs. Quality of life remains a significant concern among ESRD patients and the physicians and medical professionals responsible for their care. Unfortunately, the rehabilitation potential of many patients, despite the availability of Epo, and the success of transplantation, remains unmet.