PDG1 RECOMBINANT HUMAN ERYTHROPOIETIN VERSUS PLACEBO OR NO TREATMENT IN PATIENTS WITH ANEMIA OF CHRONIC KIDNEY DISEASE: META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Abstract

Chronic kidney disease (CKD) is associated with anemia due to decrease erythropoietin production by kidney. Several erythropoiesis-stimulating agents (ESAs) are available for treating anemia in people with CKD. The aim of this study was to evaluate the relative efficacy of recombinant human erythropoietin (rHuEPO) and safety by meta-analysis. We searched the MEDLINE database (up to March 2019) using search terms relevant to this review for. Randomized controlled trials (RCTs) and quasi-RCTs, that included a comparison of rHuEPO with placebo or no treatment in adults with CKD, and that reported prespecified patient-relevant outcomes. Only published data were used. Quality assessment was performed by two assessors independently. were expressed as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI). Ten studies (13 reports) with a total of 1080 participants (499 pre-dialysis patients, and 581 patients on hemodialysis) reported in published papers, were included in this meta-analysis. rHuEPO therapy produced a marked improvement in hemoglobin (MD 1.69 g/dL, 95% CI 1.57 to 1.82; p < 0.00001) and hematocrit (MD 9.21%, 95% CI 7.97% to 10.45%; p < 0.00001) levels as well as prevented blood transfusions (RR 0.13, 95% CI 0.06 to 0.27; p < 0.00001) compared to placebo. The risk of increase in or introduction of antihypertensive treatment was 2.64 times higher in rHuEPO-treated group than in control group in population of patients on hemodialysis (RR 2.46, 95% CI 1.24 to 4.90; p = 0.01) however it was less certain for pre-dialysis patients (RR 1.38, 95% CI 0.94 to 2.01; p = 0.10). No significant increase in other adverse events was identified. The rHuEPO therapy allows to correct the symptoms attributable to anemia of CKD, avoid blood transfusions, and significantly improve the overall quality of life.