Frequency of administration of erythropoiesis‐stimulating agents for the anaemia of end‐stage kidney disease in dialysis patients

摘要: Background The benefits of erythropoiesis-stimulating agents (ESA) for dialysis patients have been demonstrated. However, it remains unclear whether the efficacy and safety new, longer-acting ESA given less frequently is equivalent to recombinant human erythropoietin (rHuEPO) preparations. This an update a review first published in 2002 last updated 2005. Objectives This aimed establish optimal frequency administration terms effectiveness (correction anaemia, freedom from adverse events) efficiency (optimal resource use) different dose regimens. Search methods We searched Cochrane Renal Group's Specialised Register 21 March 2013 through contact with Trials' Search Co-ordinator using search relevant this review. Selection criteria We included randomised control trials (RCTs) comparing frequencies patients. Data collection analysis Two authors independently assessed study eligibility, risk bias extracted data. Results were expressed as ratio (RR) or differences (RD) 95% confidence intervals (CI) dichotomous outcomes. For continuous outcomes mean difference (MD) standardised (SMD) was used. Statistical analyses performed random-effects model. Main results This 33 studies (5526 participants), 22 which added update. Risk generally high; only nine at low sequence generation 14 allocation concealment. Although four placebo-controlled, all considered be performance detection because primary outcome haemoglobin level laboratory-derived assessment unlikely influenced by lack blinding. We found that 16 attrition five selection bias; one reporting sources support not funded pharmaceutical company. We compared interventions: Continuous receptor agonists (CERA) versus other (darbepoetin rHuEPO); darbepoetin administration; rHuEPO; rHuEPO administration. There no significant maintaining final between CERA administered two weekly (4 studies, 1762 participants: MD 0.08 g/dL, CI -0.04 0.21) (two 1245 -0.03 -0.17 0.12) three intervals. In every weeks once/week, there (313 0.30 0.05 0.55). comparisons once/week once 356 0.04 -0.45 0.52) monthly (one study, 64 0.40 -0.37 1.17) levels. There marked heterogeneity among possibly related protocols. Eight times/week; statistical demonstrated (6 1638 0.02 -0.09 0.12). Fourteen rHuEPO. No (7 393 SMD -0.39 0.05). Adverse events did differ significantly within comparisons; however, mortality quality life poorly reported, particularly earlier publications. Authors' conclusions Longer-acting CERA) week are non-inferior times/week achieving targets without any haemodialysis patients. Additional RCTs required evaluate peritoneal paediatric compare (such CERA).