University of California, San Francisco, CA, USA.
Am J Kidney Dis. 2010 Mar;55(3):535-48. doi: 10.1053/j.ajkd.2009.12.018. Epub 2010 Feb 4.
The role of erythropoiesis-stimulating agents (ESAs) in treating the anemia of chronic kidney disease has been reevaluated in view of recent studies suggesting that the use of these agents may be associated with increased morbidity and mortality. This potential increased risk needs to be weighed against the potential benefit of ESAs in improving various aspects of health-related quality of life, in particular, exercise tolerance and physical functioning.
A systematic review and meta-analysis of exercise tolerance and physical functioning.
SETTING & PARTICIPANTS: Adults on maintenance dialysis therapy.
Outcomes measured before and after ESA treatment were required. Studies of physical function were required to include at least 25 participants.
Treatment with any ESA.
Exercise tolerance measured using VO(2peak) (oxygen consumption per minute at the peak workload during the test), duration of exercise, or 6-minute walk distance or physical functioning assessed using > or = 1 patient- or clinician-reported outcome measure that included a physical function domain.
28 articles met criteria for inclusion for evaluation of exercise tolerance, and 14 articles, for physical function. Meta-analysis showed a 23.8% increase in VO(2peak) from before to after erythropoietin therapy initiation (15 studies) and a nonsignificant 8.2% increase comparing a higher with a lower hemoglobin target (3 studies). For physical functioning, 4 studies met criteria for inclusion in the meta-analysis: there was a 10.5% increase in Karnofsky score from before to after erythropoietin therapy initiation.
Many studies of exercise tolerance did not include control groups. A wide variety of instruments was used to assess physical function.
Partial correction of anemia through ESA treatment has a consistent and positive impact on VO(2peak). ESA treatment improves patient- and clinician-assessed physical functioning.
鉴于最近的研究表明，使用促红细胞生成素刺激剂（ESAs）可能与发病率和死亡率增加有关，因此重新评估了 ESAs 在治疗慢性肾脏病贫血中的作用。这种潜在的风险增加需要与 ESAs 在改善健康相关生活质量的各个方面的潜在益处相权衡，特别是运动耐量和身体机能。
对运动耐量和身体机能进行系统评价和荟萃分析。
接受维持性透析治疗的成年人。
需要测量 ESA 治疗前后的结果。需要包含至少 25 名参与者的体力功能研究。
任何 ESA 治疗。
使用 VO(2peak)（测试中峰值工作量时每分钟的耗氧量）、运动持续时间或 6 分钟步行距离来衡量运动耐量，或使用 > 或 = 1 项包含身体功能域的患者或临床医生报告的结局测量来评估身体机能。
28 篇文章符合纳入标准，可评估运动耐量，14 篇文章可评估身体机能。荟萃分析显示，起始红细胞生成素治疗后 VO(2peak)增加了 23.8%（15 项研究），与血红蛋白较低目标相比，血红蛋白较高目标时仅增加了 8.2%（3 项研究）。对于身体机能，有 4 项研究符合纳入荟萃分析的标准：起始红细胞生成素治疗后，Karnofsky 评分增加了 10.5%。
许多运动耐量研究没有对照组。评估身体机能使用了多种仪器。
ESA 治疗部分纠正贫血可对 VO(2peak)产生一致的积极影响。ESA 治疗可改善患者和临床医生评估的身体机能。
