dc.date.accessioned2019-02-22T14:56:08Z
dc.date.available2019-02-22T14:56:08Z
dc.date.created2019-02-22T14:56:08Z
dc.date.issued2015
dc.identifierhttps://hdl.handle.net/20.500.12866/5834
dc.identifierhttps://doi.org/10.1002/14651858.CD011122.pub2
dc.description.abstractBackground: 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.
dc.languageeng
dc.publisherWiley
dc.relationCochrane Database of Systematic Reviews
dc.relation1469-493X
dc.rightshttps://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.subjectHumans
dc.subjecthemoglobin
dc.subjectanemia
dc.subjecthypertension
dc.subjectmortality
dc.subjecterythropoietin
dc.subjecthuman
dc.subjectpriority journal
dc.subjectcomplication
dc.subjectplacebo
dc.subjectRenal Dialysis
dc.subjectdeep vein thrombosis
dc.subjectthrombosis
dc.subjectReview
dc.subjectsystematic review
dc.subjectErythropoietin
dc.subjectAnemia
dc.subjectheart infarction
dc.subjecthemoglobin blood level
dc.subjectcardiovascular mortality
dc.subjecthemodialysis
dc.subjectKidney Failure, Chronic
dc.subjectrenal replacement therapy
dc.subjectbrain hemorrhage
dc.subjectbrain ischemia
dc.subjecterythrocyte transfusion
dc.subjectend stage renal disease
dc.subjectperitoneal dialysis
dc.subjectantianemic agent
dc.subjectdialysis vascular access thrombosis
dc.subjectHematinics
dc.subjectperipheral arterial thrombosis
dc.titleEarly versus delayed erythropoietin for the anaemia of end-stage kidney disease
dc.typeinfo:eu-repo/semantics/review


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