title: Erythropoiesis-stimulating agents (ESA) for preventing the progression of chronic kidney disease: a meta-analysis of 19 studies.
abstract: BACKGROUND
  The effect of anemia correction on kidney function in chronic kidney disease (CKD) patients remains unclear. As 19-40% of patients with CKD receive an erythropoiesis-stimulating agent (ESA), this is a potentially important consideration.
  
  
  CONCLUSIONS
  We conducted a systematic review and meta-analysis of randomized trials to January 1, 2014 in adult patients with CKD stages 1 to 4.
  
  
  METHODS
  randomized controlled trials of at least 2 months duration. Patients were allocated to ESA versus placebo, no treatment, or different ESA doses with the purpose of achieving a higher versus a lower hemoglobin target. The analyzed outcomes were the need for renal replacement therapy, doubling of serum creatinine, change in GFR (ml/min), mortality and withdrawal of treatment due to adverse events. A total of 19 trials (n = 8,129 participants with CKD stage 1-4) were reviewed. There was no difference in the risk of end-stage kidney disease (RR, 0.97 [CI 0.83-1.20], 17 trials, 8,104 participants), change in GFR (Mean Difference [MD] -0.45 [-2.21, 1.31], 9 trials, 1,848 participants) or withdrawal of treatment due to adverse events (RR, 1.18 [CI 0.77-1.81], 10 trials, n = 1,958 participants) for patients at higher hemoglobin (Hb) targets. Furthermore, no statistically significant differences in mortality (Risk Ratio [RR] 1.10 [CI 0.90-1.35], 16 trials, n = 8,082 participants) were observed. Key Messages: There is no evidence that ESA treatment affects renal function in patients with CKD. Use of these agents should not therefore be influenced by considerations about influencing CKD progression.
authors.affiliation: Nephrology Department, Faculty of Medicine, University of Medicine and Pharmacy 'Gr. T. Popa', Iasi, Romania.
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
authors.forename: Ionut
authors.initials: I
authors.lastname: Nistor
authors.forename: Mihaela-Dora
authors.initials: MD
authors.lastname: Donciu
authors.forename: Raluca
authors.initials: R
authors.lastname: Dumea
authors.forename: Davide
authors.initials: D
authors.lastname: Bolignano
authors.forename: David
authors.initials: D
authors.lastname: Goldsmith
mesh_terms: D000740:Anemia / Q000097:blood* / Q000150:complications; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D004334:Drug Administration Schedule; D005919:Glomerular Filtration Rate; D006397:Hematinics / Q000627:therapeutic use*; D006454:Hemoglobins / Q000737:chemistry; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D011507:Proteinuria / Q000378:metabolism; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D003404:Creatinine