title: 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.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Nephrology, Centro Hospitalar de Setubal, Setubal, Portugal. jose.m.vinhas@gmail.com
authors.forename: J
authors.initials: J
authors.lastname: Vinhas
authors.forename: C
authors.initials: C
authors.lastname: Barreto
authors.forename: J
authors.initials: J
authors.lastname: Assunção
authors.forename: L
authors.initials: L
authors.lastname: Parreira
authors.forename: A
authors.initials: A
authors.lastname: Vaz
mesh_terms: D000328:Adult; D000740:Anemia / Q000188:drug therapy* / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000401:mortality*; D015897:Comorbidity; D004921:Erythropoietin / Q000627:therapeutic use*; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000401:mortality*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D006397:Hematinics; D004921:Erythropoietin