An updated Cochrane review [Abstract] 1 included 19 studies with a total of 993 subjects. There was a marked improvement in haemoglobin (WMD 1.90 g/dl, 95% CI -2.34 to -1.47) and haematocrit (WMD 9.85%, 95% CI 8.35 to 11.34) with treatment and a decrease in the number of patients requiring blood transfusions (RR 0.32, 95% CI 0.12 to 0.83). The data from studies reporting quality of life or exercise capacity demonstrated an improvement in the treatment group. Most of the measures of progression of renal disease showed no statistically significant difference. No significant increase in adverse events was identified.
Authors' comment: Based on the current evidence, decisions on whether the putative benefits in terms of quality of life are worth the extra costs of pre-dialysis rHu EPO need careful evaluation.
A meta-analysis 2 included 9 randomised controlled trials involving a total of 5 143 patients. There was a higher risk of all-cause mortality (RR 1.17, 95% CI 1.01 to 1.35; p=0.031) and arteriovenous access thrombosis (RR 1.34, 95% CI 1.16 to 1.54; p=0.0001) in the higher haemoglobin target group (haemoglobin over 120 g/l) than in the lower haemoglobin target group (haemoglobin 90-120 g/l) in the fixed effects model without heterogeneity between studies. There was a higher risk of poorly controlled blood pressure (RR 1.27, 95% CI 1.08 to 1.50; p=0.004) in the higher haemoglobin target group than in the lower target haemoglobin group with the fixed effects model; however, this was not significant in the random effects model (RR 1.31, 95% CI 0.97 to 1.78; p=0.075). The incidence of myocardial infarction was much the same in the two groups.
A Cochrane review [Abstract] 3 included 117 studies invovling a total of 25 237 participants. There were no difference in blood transfusions or death in comparison between epoetin/darpoetin/biosimilars and placebo.
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