Safety issues related to erythropoiesis-stimulating agents used to treat anemia in patients with chronic kidney disease.
BACKGROUND
Erythropoiesis-stimulating agents (ESAs) have been the main therapy for anemia in CKD patients since the late eighties. Since then, treatment indications have progressively changed, together with a progressive increase in therapeutic targets, in terms of hemoglobin levels.


METHODS
This paper discusses possible concerns about ESA use and increased cardiovascular risk (in particular stroke), hypertension, cancer progression and the development of pure red cell aplasia. A literature search was done on PubMed to obtain studies about the adverse effects of ESA in the CKD population.


CONCLUSIONS
The publication of the TREAT study has largely contributed to the concerns about ESA use, indicating that complete anemia correction may not be safe in the CKD population. This may be particularly true in high-risk patients, especially if hyporesponsive to ESA treatment. However, there is a gray area of no evidence either way for intermediate levels (11.5 - 13 g/dl), in comparison with higher or lower levels. New recommendations about ESA use in the CKD population by the Food and Drug Administration seem to move toward treatment individualization.
Department of Nephrology and Dialysis, Ospedale A. Manzoni, Via dell'Eremo 9, 23900 Lecco, Italy.
Lucia
L
Del Vecchio
Francesco
F
Locatelli
D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D000818:Animals; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000503:physiopathology; D006397:Hematinics / Q000009:adverse effects* / Q000627:therapeutic use; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D009369:Neoplasms / Q000473:pathology; D012010:Red-Cell Aplasia, Pure / Q000139:chemically induced; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012307:Risk Factors; D014481:United States; D014486:United States Food and Drug Administration
D006397:Hematinics; D006454:Hemoglobins