Abstract
Objectives: Patients with chronic kidney disease (CKD) develop anemia which is treated with erythropoietin-stimulating agents (ESAs). However, ESAs do not reduce the risk of cardiovascular mortality. Furthermore, this is unclear whether ESAs therapy has any association with adverse cardiovascular events.Methods: After an informed consent 275 male and female patients, between ages 35 to 75 years, with CKD stage V on ESAs undergoing twice weekly hemodialysis were enrolled. The dose of ESAs was calculated according to weight as 50mg/kg with target hemoglobin being 11 – 12 g/dl. Dose adjustments were made in the patients who failed to achieve target hemoglobin. The patients were followed for a year with the primary end point being new evidence of acute myocardial infarction (MI) diagnosed through ECG or echocardiography. Safety outcomes included stroke or death.Results: The data was entered and analyzed in Statistical Package for Social Sciences (SPSS) version 18Out of 275 patients, 164 (59.6%) patients were males and 111 (40.4%) were females. Mean age of the patients was 51.52 with standard deviation of ± 5.73. According to the results, 52 (18.9%) patients reported with MI and 223 (81.1%) patients had no evidence of MI. Out of 52 patients who had MI, 37 (71.1%) were males and 15 (28.8%) patients were female.Conclusion: ESAs are associated with an increased risk of MI in CKD patients on hemodialysis. Whether there is a direct association or there are other factors involved remains to be seen.
Highlights
Chronic kidney disease (CKD), caused by diabetes mellitus, hypertension and other diseases, is characterized by a progressive decline in the estimated glomerular filtration rate; the diagnosis is confirmed via a reduced GFR for a minimum of 3 months often accompanied by albuminuria.[1,2]
The dose was initiated according to the weight as 50 mg/kg to achieve partial correction of hemoglobin dose adjustments were made in those cases who failed to achieve target hemoglobin as per KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease by National Kidney Foundation
Patients, assessed for Myocardial Infarction (MI), were without known coronary artery disease or previous MI.With 95% Confidence Interval, it was observed that out of 275 patients of ESRD, only 52 (18.9%) patients were reported with MI, 223 (81.1%) patients did not report any incident of myocardial infarction
Summary
Chronic kidney disease (CKD), caused by diabetes mellitus, hypertension and other diseases, is characterized by a progressive decline in the estimated glomerular filtration rate (eGFR); the diagnosis is confirmed via a reduced GFR for a minimum of 3 months often accompanied by albuminuria.[1,2] In CKD stage V characterized by total or near-total loss of kidney function, there is accumulation of fluid and toxic substances and patients require hemodialysis or transplanttation to sustain their life and daily activities.[2,3,4]The decrease in the production of erythropoietin, caused by renal insufficiency and the antiproliferative effects of the uremic toxins being accumulated in the body, results in anemia of chronic kidney disease.[5]. Chronic kidney disease (CKD), caused by diabetes mellitus, hypertension and other diseases, is characterized by a progressive decline in the estimated glomerular filtration rate (eGFR); the diagnosis is confirmed via a reduced GFR for a minimum of 3 months often accompanied by albuminuria.[1,2] In CKD stage V characterized by total or near-total loss of kidney function, there is accumulation of fluid and toxic substances and patients require hemodialysis or transplanttation to sustain their life and daily activities.[2,3,4]. In patients with CKD, who are receiving maintenance hemodialysis, treatment of anemia to achieve hemoglobin levels of 11 – 12 g/dl with the use of erythropoietin stimulating agents (ESA) leads to correction of the anemia and elimination of the need for blood transfusions albeit with an increased incidence of potentially fatal adverse effects.[5,6,7,8] The present study was ANNALS VOL 23, ISSUE 2, APR. – JUN. 2017
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