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Original Paper

Treatment of Anaemia with Erythropoiesis-Stimulating Agents in Patients with Chronic Kidney Disease Does Not Lower Mortality and May Increase Cardiovascular Risk: A Meta-Analysis

Vinhas J. · Barreto C. · Assunção J. · Parreira L. · Vaz A.

Author affiliations

Department of Nephrology, Centro Hospitalar de Setubal, Setubal, Portugal

Related Articles for ""

Nephron Clin Pract 2012;121:c95–c101

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: July 10, 2012
Accepted: October 06, 2012
Published online: November 22, 2012
Issue release date: February 2013

Number of Print Pages: 7
Number of Figures: 5
Number of Tables: 3


eISSN: 1660-2110 (Online)

For additional information: http://www.karger.com/NEC

Abstract

Background/Aims: Interpretation of the results of earlier meta-analyses in chronic kidney disease (CKD) patients on the impact of anaemia treatment with erythropoiesis-stimulating agents (ESAs) on clinical outcomes has been hampered by the inclusion of small trials and trials of short duration. We re-evaluated the benefits and harms of treating anaemia, including only relevant clinical trials. Methods: We conducted a systematic review and meta-analysis of randomised controlled trials performed in adults with CKD which allocated patients to different doses of ESAs, and we compared the effect of these interventions on vascular access thrombosis, stroke, risk of end-stage renal disease (ESRD) and all-cause mortality. Additional inclusion criteria were studies with a duration of at least 1 year and enrolling more than 500 participants. Results: Five trials (7,902 participants) met the inclusion criteria and were included in the meta-analysis. The number of patients enrolled in each trial ranged from 596 to 4,038. The mean/median duration of follow-up ranged from 14 to 36 months. A higher haemoglobin target was associated with increased risk of vascular access thrombosis (RR 1.343; 95% CI 1.162–1.554; p = 0.0005) and stroke (RR 1.735; 95% CI 1.323–2.275; p = 0.0005), and no effect on risk of ESRD (RR 1.089; 95% CI 0.986–1.203; p = 0.094) or all-cause mortality (RR 1.148; 95% CI 0.977–1.350; p = 0.093). Conclusion: In CKD patients, treatment of anaemia with ESAs targeting a higher haemoglobin value does not lower mortality or reduce the risk of ESRD, and may increase cardiovascular risk.

© 2012 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: July 10, 2012
Accepted: October 06, 2012
Published online: November 22, 2012
Issue release date: February 2013

Number of Print Pages: 7
Number of Figures: 5
Number of Tables: 3


eISSN: 1660-2110 (Online)

For additional information: http://www.karger.com/NEC


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