The Impact of Anemia Treatment on Health-Related Quality of Life in Patients With Chronic Kidney Disease in the Contemporary Era

In summary, the treatment of anemia in CKD and ESRD patients improves the HRQOL of patients, primarily impacting the domains of vitality/energy and physical functioning. KDIGO has outlined a reasonable approach for the routine use of ESAs for CKD and ESRD patients.1K/DIGO Kidney Int Suppl. 2012Google Scholar Importantly, the impact of anemia treatment on individual patients will vary. In assessing that impact, attention needs to be focused primarily on the domains of energy/vitality and physical functioning, although other domains may be impacted as well. HRQOL measures that can be useful in this regard include physical functioning and energy/vitality domains of the SF-36, FACT-Fatigue questionnaire, the physical symptoms and fatigue domains on the KDQ questionnaire, and various fatigue questionnaires recommended by Patient-Reported Outcomes Measurement Information System. The appropriate target Hgb level for each patient may vary and assessing each patient's symptom burden and response to therapy is important to incorporate into each patient's plan of care and treatment goals. This is particularly important as nephrology moves to a more patient-centered care approach and emphasis is placed on individualization of care.13Finkelstein F.O. Finkelstein S.H. Time to rethink our approach to patient-reported outcome measures for ESRD.Clin J Am Soc Nephrol. 2017; 12: 1885-1888Crossref PubMed Scopus (26) Google Scholar, 14Kliger A.S. Quality measures for dialysis: time for a balanced scorecard.Clin J Am Soc Nephrol. 2016; 11: 363-368Crossref PubMed Scopus (42) Google Scholar In other words, rather than simply applying standardized algorithms for anemia treatment for all patients, consideration needs to be given assessing the potential benefits of anemia treatment on the individual patient, incorporating routine assessments of HRQOL into standard routine patient care.