Controlled Study on the Improvement of Quality of Life in Elderly Hemodialysis Patients After Correcting End-Stage Renal Disease-Related Anemia With Erythropoietin Fuensanta Moreno, MD, Francisco J. Aracil, MD, Rafael P&e& MD, and Fernando Valderrhbano, MD 0 Despite the long experience in erythropoietin (EPO) treatment in end-stage renal disease (ESRD)-related anemia, controversy remains as to whether EPO treatment of anemia can improve the quality of life (QL) in elderly ESRD patients, as it does in younger ones. We conducted a prospective study of 57 stable patients on hemodialysis who started on EPO treatment. A control group of 29 hemodialysis patients not requiring EPO was simultaneously studied. Diabetic patients and patients with severe comorbidity were excluded. Quality of life was assessed at baseline before EPO treatment and after 3 and 6 months of follow-up, using the Karnofsky scale (KS) and the Sickness Impact Profile (SIP) questionnaire. A high KS score and a low SIP score indicate better QL. Erythropoietin patients were stratified into two age groups: ~60 years (n = 34) and 260 years (n = 23). In the EPO group mean hematocrit values improved from 21% at baseline to 29% at the sixth month; mean KS scores increased from 66 2 1.8 to 81 ? 1.5 (P < 0.9091) and the mean global score of SIP decreased from 19.8 2 1.6 to 13.5 t 1.2 (P < 0.9991). No significant changes were observed in the control group. Elderly patients in the EPO group showed improved KS scores, from 61 t 1.5 to 75 rf: 2.5 (f < O.ooOl), and the global score of SIP decreased from 27.7 2 2.1 to 20 t 1.8 (P < 0.991). Younger patients had improvement of their KS scores, from 73 i 2.5 to 85 t 1.5 (P < O.CUKll), and the global score of SIP decreased from 14.5 + 1.9 to 9.1 t 1.2 (P < 0.991). No relationship was found between age groups and improvement in QL indicator scores. On regression analysis, a poor basal QL score was related to higher QL improvement under EPO treatment, and final hematocrit was positively related to global SIP improvement. Treatment of ESRD-related anemia with EPO significantly improved the QL of hemodialy- sis patients. Quality of life in elderly patients improved as much as in younger patients, thereby fully justifying the use of EPO for the elderly. 0 1996 by the National Kidney Foundation, Inc. INDEX WORDS: Quality of life; erythropoietin; elderly; hemodialysis; kidney failure; Sickness Impact Profile; anemia; hematocrit. E ND-STAGE renal disease (ESRD)-related anemia continues to be a frequent cause of fatigue, physical distress, and overall “poor health,” especially in patients starting renal re- placement therapy. These symptoms may be at- tributed to uremia, but they usually disappear or attenuate after successful treatment of anemia with erythropoietin (EPO).’ Anemia usually con- tributes to inadequate physical, social, and work- related rehabilitation. Several studies have shown that treatment of ESRD-related anemia with EPO From the Division of Nephrology, Hospital Universitario Pn’ncipe de Asturias, Alcald de Henares, Madrid; the Depart- ment of Especialidades Midicas, Universidad de Alcala’ de Henares, Madrid; and Division of Nephrology, Hospital Gen- eral Universitario Gregorio Maraiio’n, Madrid, Spain. Received February 23, 1995; accepted in revised form November 17, 1995. Address reprint requests to Fuensanta Moreno, MD, Ser- vicio de Nefrologia, Hospital Universitario Principe de As- turias, Carretera Alcaki-Meco S/N (Campus Universitario), Alcald de Henares, 28805 Madrid, Spain. 0 1996 by the National Kidney Foundation, Inc. 0272.6386/96/2704-0012$3.00/O improves quality of life (QL) in patients on chronic hemodialysis.2-4 Erythropoietin has been widely used in the treatment of ESRD anemia. However, clinical studies have not identified individual, environ- mental, or therapy-related factors that can affect QL improvement in patients receiving EPO treat- ment. The number of elderly patients on hemodialy- sis has been progressively increasing over the past few years. By the end of this decade, 60% of patients on hemodialysis will be over 65 years old.5 Apart from their ESRD, these patients have a higher comorbidity, decreased physical capac- ity, and an overall poorer QL than younger pa- tients. Although the number of elderly patients on hemodialysis is large, little is known about the impact on QL of correcting anemia in elderly patients with EPO. Some investigators have even pointed out that there are some doubts as to the improvement of elderly patients’ QL with this treatment.6 The objectives of our study were first, to ascer- tain whether EPO treatment for ESRD-related 548 American Journal of Kidney Diseases, Vol 27, No 4 (April), 1996: pp 548-556