Staibano Phillip, Perelman Iris, Lombardi Julia, Davis Alexandra, Tinmouth Alan, Carrier Marc, Stevenson Ciara, Saidenberg Elianna
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Kidney Dis (Basel). 2020 Mar;6(2):74-84. doi: 10.1159/000502208. Epub 2019 Nov 19.
Anaemia is a nearly universal complication of chronic kidney disease (CKD). Erythropoiesis-stimulating agents (ESAs) have been demonstrated to improve clinical outcomes and quality of life (QOL) in renal patients with anaemia. Patient-reported outcome measures (PROMs) are increasingly being used to evaluate the patient-centred impact of medical therapy. Here, we describe a systematic review of studies that evaluated patient-centred outcomes (PCOs) in renal patients undergoing anaemia treatment.
We conducted a search of Medline (Ovid), EMBASE (Ovid), PsychINFO, and CINAHL databases for studies published until March 2018 that investigated an intervention to treat anaemia in renal patients and used at least one PROM. We also performed a quality assessment for all included studies. Statistical analyses characterized each study, PROMs used, the quality of PCO reporting, and the association between haematological outcomes and PCOs.
Of the 3,533 studies identified in the database search, 21 met all eligibility criteria. Fourteen (67%) of the studies were randomized-controlled trials. Most studies (81%) investigated CKD patients, 14% investigated post-renal transplant patients and 5% assessed patients with heart disease on haemodialysis. The most common anaemia intervention, used in 95% of studies, was ESAs. Forty-three percent of studies utilized one PROM, most commonly the SF-36, a measure of QOL not specifically created for use in nephrology patients. About a third of studies selectively reported PROM subscales, rather than reporting all subscales. Notable biases among included studies included lack of blinding, selective outcome reporting, and lack of power estimates for PCOs. We did not find a statistically significant association between improvements in haemoglobin and QOL.
Future studies employing anaemia and nephrology-specific PROMs and conducted with greater rigour, standardization in the research methods, and reporting of PCOs in renal populations will improve understanding of PCOs in this patient group and hopefully improve patient outcomes and experiences.
贫血是慢性肾脏病（CKD）几乎普遍存在的并发症。促红细胞生成素（ESA）已被证明可改善肾性贫血患者的临床结局和生活质量（QOL）。患者报告结局指标（PROM）越来越多地用于评估以患者为中心的药物治疗效果。在此，我们描述了一项对评估接受贫血治疗的肾病患者以患者为中心结局（PCO）的研究的系统评价。
我们检索了Medline（Ovid）、EMBASE（Ovid）、PsychINFO和CINAHL数据库，查找截至2018年3月发表的研究，这些研究调查了治疗肾性贫血的干预措施并使用了至少一项PROM。我们还对所有纳入研究进行了质量评估。统计分析描述了每项研究、所使用的PROM、PCO报告的质量以及血液学结局与PCO之间的关联。
在数据库检索中识别出的3533项研究中，21项符合所有纳入标准。其中14项（67%）研究为随机对照试验。大多数研究（81%）调查了CKD患者，14%调查了肾移植术后患者，5%评估了接受血液透析的心脏病患者。95%的研究中使用的最常见贫血干预措施是ESA。43%的研究使用了一项PROM，最常用的是SF - 36，这是一种并非专门为肾病患者设计的生活质量测量工具。约三分之一的研究选择性报告PROM分量表，而非报告所有分量表。纳入研究中的显著偏倚包括缺乏盲法、选择性结局报告以及缺乏PCO的效能估计。我们未发现血红蛋白改善与生活质量之间存在统计学显著关联。
未来采用贫血和肾病特异性PROM且研究方法更严谨、标准化以及在肾性人群中报告PCO的研究，将增进对该患者群体PCO的理解，并有望改善患者结局和体验。
