title: Erythropoietin and resistant hypertension in CKD.
abstract: There is a well-documented association between erythropoiesis-stimulating agents (ESAs) and hypertension in chronic kidney disease. Studies suggest that the mechanism for this is multifactorial. First, some chronic kidney disease patients may have a limited ability to accommodate a rapid increase in red cell volume because of a decreased glomerular filtration rate, left ventricular hypertrophy, and decreased arterial compliance. Second, there is likely a direct vasoconstrictor effect of ESAs. Although no large randomized controlled trials of ESAs have been designed with blood pressure as an a priori outcome, several meta-analyses have explored this relationship and generally support the existence of ESA-induced hypertension. There are as of yet no data directly linking ESA-induced hypertension with increased cardiovascular morbidity and mortality. Despite this, clinicians should be vigilant for ESA-induced hypertension, use caution when using ESAs in patients with resistant hypertension, and be attentive to the rate of hemoglobin increase in patients with poorly controlled blood pressure.
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA. Electronic address: bernsj@uphs.upenn.edu.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Boyle
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Berns
mesh_terms: D000740:Anemia / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects*; D004351:Drug Resistance; D019332:Endothelin-1 / Q000378:metabolism; D004921:Erythropoietin / Q000009:adverse effects*; D006397:Hematinics / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000503:physiopathology*; D009569:Nitric Oxide / Q000378:metabolism; D011994:Recombinant Proteins / Q000009:adverse effects; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012084:Renin-Angiotensin System / Q000502:physiology
chemical_list: D019332:Endothelin-1; D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin; D009569:Nitric Oxide
keywords: Erythropoietin-stimulating agents; anemia; chronic kidney disease; hypertension