Therapy with erythropoiesis-stimulating agents and renal and nonrenal outcomes

Abstract

The effect of erythropoiesis-stimulating agents (ESAs) on renal and cardiovascular outcomes in patients with chronic kidney disease (CKD) and heart failure (HF) is uncertain. Observational data indicate a strong relationship between the severity of anemia and poor outcome. On the other hand, randomized controlled trials on patients with CKD indicate that ESAs used in targeting a higher hemoglobin concentration result in increased risk. This article reviews the observational data as well as the recent information from randomized trials that point to increased risk in CKD and HF settings, and whether these disparate results can be explained by exposure to ESAs in this setting.