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Kidney Disease Therapy May Increase Cardiovascular Risks

Therapy targeting higher hemoglobin levels in CKD patients linked to increased risks

TUESDAY, May 4 (HealthDay News) -- For patients with chronic kidney disease (CKD), therapy with erythropoiesis-stimulating agents (ESA) that target higher levels of hemoglobin increases the risk of stroke, hypertension and thrombosis, according to a meta-analysis published online May 3 in the Annals of Internal Medicine.

Suetonia C. Palmer, of the University of Otago in Christchurch, New Zealand, and colleagues reviewed the medical literature from 1966 to 2010 for studies evaluating ESA treatment in patients with CKD, including hemoglobin target trials and trials that compared ESA with no treatment or placebo. The reviewers pooled the data and conducted a meta-analysis.

Twenty-seven trials involving 10,452 patients met the criteria for inclusion. The researchers found that setting a higher hemoglobin target was associated with increased risks for hypertension (relative risk [RR], 1.67), stroke (RR, 1.51), and vascular access thrombosis (RR, 1.33) compared to a lower hemoglobin target. However, they observed no statistically significant differences in risks for mortality, end-stage kidney disease or serious cardiovascular events. The reviewers found treatment effects were similar for CKD at all stages.

"Targeting higher hemoglobin levels in CKD increases risks for stroke, hypertension, and vascular access thrombosis and probably increases risks for death, serious cardiovascular events, and end-stage renal disease. The mechanisms for harm remain unclear, and meta-analysis of individual-patient data and trials on fixed ESA doses are recommended to elucidate these mechanisms," the authors write.

Several study authors disclosed financial ties to pharmaceutical companies.

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