Quality of life and hematocrit level

As the anemia that accompanies chronic renal failure (CRF) is successfully treated with recombinant human erythropoietin (epoetin), striking improvements in overall quality of life have been noted in several clinical studies of patients receiving chronic hemodialysis. A review of available clinical data has shown that, following epoetin therapy, peak oxygen consumption, a principal indicator of exercise ability, increased by approximately 50% as the hematocrit level increased. Following epoetin therapy in pediatric patients with end-stage renal disease (ESRD), the ventilatory anaerobic threshold (VAT) increased significantly and correlated well with increases in hemoglobin concentrations. Increased exercise capacity associated with the reversal of anemia appeared to positively effect many quality-of-life parameters. Analysis of questionnaires incorporating both subjective and objective quality-of-life indicators showed significant improvements between baseline and follow-up periods. Many patients experienced relief from some of the debilitating symptoms of anemia and many had significantly improved functional ability. Higher activity and energy levels were reflected in enhanced emotional and social well-being, with improvements noted in appetite, sleeping behavior, and sexual function. There was no change in the employment status of most patients. The extent of improvement in overall quality of life may be a function of the baseline level of impairment and the potential for reversal. However, baseline capabilities at rest may not be appropriate for physiologic studies.