Effect of Erythropoietin Stimulating Agents on Cardiovascular Events in Chronic Kidney Disease Patients on Hemodialysis
Keywords:Chronic Kidney Disease, Erythropoietin stimulating agents, Myocardial Infarction, Anemia
Objectives: Patients with chronic kidney disease (CKD) develop anemia which is treated with erythropoietin-stimulating agents (ESAs). However, ESAs do not reduce the risk of cardiovascular mortality. Furthermore, this is unclear whether ESAs therapy has any association with adverse cardiovascular events.
Methods: After an informed consent 275 male and female patients, between ages 35 to 75 years, with CKD stage V on ESAs undergoing twice weekly hemodialysis were enrolled. The dose of ESAs was calculated according to weight as 50mg/kg with target hemoglobin being 11 – 12 g/dl. Dose adjustments were made in the patients who failed to achieve target hemoglobin. The patients were followed for a year with the primary end point being new evidence of acute myocardial infarction (MI) diagnosed through ECG or echocardiography. Safety outcomes included stroke or death.
Results: The data was entered and analyzed in Statistical Package for Social Sciences (SPSS) version 18
Out of 275 patients, 164 (59.6%) patients were males and 111 (40.4%) were females. Mean age of the patients was 51.52 with standard deviation of ± 5.73. According to the results, 52 (18.9%) patients reported with MI and 223 (81.1%) patients had no evidence of MI. Out of 52 patients who had MI, 37 (71.1%) were males and 15 (28.8%) patients were female.
Conclusion: ESAs are associated with an increased risk of MI in CKD patients on hemodialysis. Whether there is a direct association or there are other factors involved remains to be seen.
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