Quality of life of patients with chronic renal allograft rejection and anemia

Background: The treatment with recombinant human erythropoietin (rHuEPO) of anemia associated with renal insufficiency (RI) improves the health-related quality of life (HRQOL) of those patients. The objective of this study was to evaluate the HRQOL of patients with chronic allograft nephropathy (CAN) and anemia associated to RI, and the effect of rHuEPO treatment on the HRQOL. Methods: This prospective study consisted of 17 kidney transplant patients with RI caused by CAN and anemia who received rHuEPO. The hemoglobin (Hb) target was 12 g/dL. Serum Hb, hematocrit (Hct) and creatinine clearance (CrCl) were collected. HRQOL was evaluated with the Kidney Disease Quality of Life Short-Form 36 (SF-36) questionnaire at the start, at the 3rd and 6th month and at the end of the follow-up. SF-36 scores eight scales, physical component summary (PCS) and mental component summary (MCS) were standardized by age and gender using the Spanish population norms. The "effect size" was also calculated for each score. Results: Hb and Hct statistically improved from the start to the 3rd month and to the end of the study (p<0.01). Although the CrCl remained stable during most of the follow-up, it worsened (p=0.002) around the 13th month. SF-36 scores at the beginning were worse than that of the general population. Three SF-36 scales statistically improved; role-physical, vitality and mental health. The effect size was moderate for pain (0.41), role-emotional (0.39) and MCS (0.42); and large for role-physical (0.65), vitality (0.81) and mental health (0.74). Conclusions: The poor HRQOL of patients with CAN and anemia improves with rHuEPO treatment, the effect size varying from moderate to large.