In patients with chronic kidney disease (CKD) and anemia, using erythropoiesis-stimulating agents (ESAs) to achieve higher hemoglobin targets increase the risk of cardiovascular events, but not the risk of end-stage renal disease (ESRD) or death, according to a recent meta-analysis by Portuguese investigators.

The meta-analysis included five randomized, controlled trials that allocated patients to different ESA doses. The five trials included a total of 7,902 subjects, with the number of patients in each trial ranging from 596 to 4,038. The mean or median duration of follow-up ranged from 14 to 36 months.

A higher hemoglobin target was associated with a significant 34% increased risk of vascular access thrombosis and a 73% increased risk of stroke, but had no effect on ESRD risk or overall mortality, Jose M. Vinhas, MD, and colleagues at Centro Hospitalar de Setubal in Setubal reported online in Nephron Clinical Practice.

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The researchers noted that interpretation of the results of earlier meta-analyses in CKD patients on the impact of anemia treatment with ESAs on clinical outcomes has been hindered by the inclusion of small trials and trials of short duration. The aim of their meta-analysis was to re-evaluate the benefits and harms of using ESAs to treat anemia in CKD patients by looking only at relevant clinical trials.