A meta-analysis of 27 trials evaluating erythropoiesis-stimulating agent (ESA) treatment in 10,452 CKD patients shows that compared with a lower hemoglobin (Hb) target, higher Hb targets are associated with a 51% increased of stroke, a 67% increased risk of hypertension, and a 33% increased risk of vascular access thrombosis. Suetonia C. Palmer, MB, ChB, and an international team reported in Annals of Internal Medicine that the mechanisms for the increased risks remain unclear.

The researchers observed no significant differences in the risks for death, serious cardiovascular events, or end-stage renal disease. In addition, treatment effects were consistent across subgroups, including all CKD stages.