The Effects of Recombinant Human Erythropoietin Therapy on Exercise Capacity and Quality of Life in Dialyzed Patients with End Stage Renal Diseae

Choi, E J; Song, H C; Jin, D C; Chang, Y S; Yun, S N; Kim, S Y; Yoon, S A; Ahn, S J; Lee, S H; Shin, Y S; Park, C H; Kim, Y W; Yang, C W; Kim, Y S; Bang, B K

Abstract

To determine whether rHuEPO improves the exercise capacity and the global quality of life, 52 nondiabetic patients with end stage renal disease undergoing dialysis (hemodialysis 42, CAPD 10, M 34, F 18) were selected from 7 affiliated hospitals with the Catholic University in Korea. We injected rHuEPO (4000 unit 3 times a week, Eprex prefilled syringe. Cilag AG, Switzerland) subcutaneous to the patients with Hb level 7-9g/dL. After reaching the target Hb level 10-12g/dL, patients were maintained for another 4 weeks. All patients received oral or intravenous iron through trial. The exercise capacity was evaluated by using a standard incremental cycle exercise protocol with treadmill, step walk load in fixed floors and the global quality of life was assessed by means of an interview based on questionnaire (scale 1-7). The initial Hb level (7.4+/-0.9g/dL) were increased to the target Hb level (10.0-12.0g/dL) on 5.5+/-2.3 week and highest level (11.8+/-1.4g/dL) on 8 week (p<0.001). In exercise capacity test, the times of step walk in established two floors before rHuEPO, on target Hb, and after 4 weeks of target level were decreased (Group A: 2 floors, n=37, 15.3+/-5.0 sec, 14.5+/-4.4 sec, 13.9+/-4.7 sec, p<0.01, Group B: 3 floors, n=13, 44.0+/-11.3 sec, 32.8+/-8.0 sec, 32.8+/-5.2 sec, p<0.01). The times of walk and the amounts of work load in treadmill before rHuEPO and after 4 weeks of target level were increased (walk time 482+/-143 sec, 572+/-147 sec, p<0.01, work load 9.4+/-2.5 mets, 11.0+/-2.5 mets. p<0.01). In the global quality of life, all the score of improvement of fatigue (4.3+/-1.1, 5.2+/-1.0, 5.4+/-1.0), the daily activity (4.8+/-1.4, 5.5+/-0.9, 5.5+/-1.1) and the quality of life (4.0+/-1.1, 4.8+/-0.7, 4.9+/-0.8) were improved (p<0.01). rHuEPO treated patients had increased blood pressure (before rHuEPO 138.8+/-21.7/82.3+/-10.5mmHg, after 4 weeks of target level 149.7+/-23.0/89.5+/-13.8mmHg, p<0.01) In conclusion, it is meaningful to maintain the Hb level of 10-12g/dL for better quality of life and exercise capacity in patients with end stage renal disease undergoing dialysis.