title: An overview on safety issues related to erythropoiesis-stimulating agents for the treatment of anaemia in patients with chronic kidney disease.
abstract: BACKGROUND
  Erythropoiesis stimulating agents (ESA) are effective drugs, which have been used for decades in patients with chronic kidney disease (CKD) with few side effects. More recently, concern has been raised around their safety, from higher cardiovascular and thrombosis risk to cancer progression and increased mortality.
  
  
  METHODS
  We made a literature search on PubMed looking for adverse effects of ESA in CKD patients. The topics covered are cardiovascular adverse events, thrombosis, increased mortality, hypertension, cancer progression, diabetic retinopathy, pure red cell aplasia and anaphylactic reactions.
  
  
  CONCLUSIONS
  Concerns around ESA therapy have questioned treatment indications in high-risk CKD patients (those with cancer, diabetes and cardiovascular comorbidities). A more cautious approach has then prevailed. In our opinion, intermediate Hb values (Hb 10-12 g/dl) should be aimed with ESA therapy, being more cautious in high-risk patients. As a consequence, IV iron is administered more frequently. However, excessive iron use may cause iron overload and in rare cases severe anaphylactic reactions. There are expectations of new erythropoietic agents, such as those manipulating the hypoxia-inducible transcription factors (HIF) system. Differing from ESAs, they stimulate the production of endogenous EPO, avoiding over-physiological plasmatic levels.
authors.affiliation: a Department of Nephrology and Dialysis , A. Manzoni Hospital , Lecco , Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Del Vecchio
authors.affiliation: a Department of Nephrology and Dialysis , A. Manzoni Hospital , Lecco , Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Locatelli
mesh_terms: D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D000818:Animals; D004921:Erythropoietin / Q000378:metabolism; D006397:Hematinics / Q000009:adverse effects* / Q000627:therapeutic use; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000008:administration & dosage / Q000009:adverse effects; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012307:Risk Factors
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D004921:Erythropoietin; D007501:Iron
keywords: Anaemia; cancer; chronic kidney disease; diabetic retinopathy; erythropoiesis stimulating agents; erythropoietin; hypertension; safety