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Objectives: Quality of life (QoL) of patients with chronic kidney disease (CKD) is severely compromised. The association between deteriorating kidney function and anemia is well established. This study assessed the impact of anemia (defined using KDIGO guidelines and/or ESA usage) on QoL in patients with CKD. MethOds: A descriptive, cross-sectional analysis of data derived from an Adelphi CKD-Disease Specific Program, which took place across Europe between June-September 2012, was conducted. Health-related QoL (HRQoL) was assessed via EQ-5D-3L, Kidney Disease and Quality of Life (KDQOL-36) measures, including Short Form-12 (SF-12). Activity impairment data were obtained from the Work Productivity and Activity Impairment questionnaire. Additional data were collected through patient-record forms completed by attending physicians. Results: A total of 1336 patient-completed questionnaires were analyzed from an evaluable population of 2898 patients with CKD (stage 3, 4, and on dialysis). Similar significant and comparable correlations were observed between serum hemoglobin levels and the extent of HRQoL scores. The mean EQ-5D utility value across all patient groups was 0.76, and values were consistently lower for anemic versus non-anemic patients. Scores on the SF-12 physical and mental composite scales, and three additional subscales of the KDQOL-36, also revealed greater impairment in anemic patients. For all patients, the EQ-5D utility value was negatively associated with severity of physician-reported patient tiredness. Activity impairment was higher in anemic versus non-anemic patients with CKD stage 3 (37.5% vs 28.4%), stage 4 (48.1% vs 39.9%), or on dialysis (52.0% vs 45.0%). Anemia appeared to accentuate the disease burden in patients with stage 4 CKD to levels typically associated with dialysis. cOnclusiOns: Disease burden in patients with CKD is driven by anemia, a potentially remediable condition. Longitudinal studies are needed with larger subgroups to rule out possible confounding variables and to understand the true impact of anemia in CKD.

Objectives: Chemotherapy-induced nausea and vomiting (CINV) is a common debilitating adverse event of chemotherapy. Antiemesis guidelines recommend combinations of neurokinin-1 receptor antagonists (NK-1 RAs) with dexamethasone and serotonin receptor antagonists (5-HT3RA) to prevent CINV in patients receiving highly emetogenic chemotherapy (HEC) and select patients receiving moderately emetogenic chemotherapy (MEC). This systematic review (SR) aimed to assess the availability of direct or indirect evidence for safety and efficacy of rolapitant versus other NK-1 RAs. MethOds: An SR was conducted to identify RCTs comparing NK-1 RAs with any comparator via MEDLINE, Embase, Cochrane library electronic databases, meeting proceedings, clinical trails.gov, World Health Organization, clinical trials registry platform, FDA.gov and the European Union Clinical trials register websites. We followed prespecified inclusion and exclusion criteria, and screened eligible studies using the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We assessed the quality of the identified evidence using a checklist recommended by NICE for RCT quality assessment. Results: Overall, 29 publications on 29 RCTs (including one RCT and its extension) met the inclusion criteria (22 full publications, and 7 conference abstracts). Complete response (no vomiting and no use of rescue medication) in the overall, delayed, and acute phase, was a primary outcome in eleven, seven, and three RCTs, respectively. Rolapitant in combination with a 5-HT3RA and dexamethasone was compared with 5HT3RA and dexamethasone alone in three RCTs, in patients undergoing HEC or MEC. No RCT compared directly rolapitant with other NK-1 RAs for CINV management; however, 19 RCTs were potentially relevant for indirect comparison. cOnclusiOns: Our review identified the RCTs evaluating NK1-RAs for CINV prevention in patients undergoing HEC or MEC. The lack of direct comparison between rolapitant and other NK-1 RAs suggests the need for a network metaanalysis indirectly comparing the effects of rolapitant with those of other NK-1 RAs.

Objectives: We examined the effect of patient centered medical home (PCMH) on health service expenditures and utilization in a national probability sample of US civilian noninstitutionalized adult population who were diagnosed with hypertension. MethOds: The 2010-2015 Medical Expenditure Panel Survey data were analyzed. Our study population was limited to noninstitutionalized US adults ≥ 18 years of age diagnosed with hypertension. We investigated the impact of PCMH on the direct hypertension-related total, inpatient, prescription medications, outpatient, emergency room, office based, and other medical expenditures by employing Log transformed multiple linear regression models and the propensity score method. Results: Of the 18,630 adults identified with hypertension, 19.2% (n = 3,583) had received PCMH care during 2010 to 2015. After matching, No PCMH group showed greater mean in all hypertension-related health service expenditures and utilization. After adjusting for confounders, PCMH group showed significant lower total, office-based, outpatient, number of office-based visits and outpatient visits compared with control group. cOnclusiOns: A significant relationship between experiencing PCMH care and a lower total health care expenditure were found among patient with hypertension. To reduce the overall cost of care for those patients, policy makers should implement new intervention strategies that are effective in facilitating the access to PCMH.

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