Erythropoiesis-stimulating agents increase the risk of acute stroke in patients with chronic kidney disease

Seliger, Stephen L.
Zhang, Amy D.
Weir, Matthew R.
Walker, Loreen
Hsu, Van Doren
Parsa, Afshin
Diamantidis, Clarissa J.
Fink, Jeffrey C.

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Publication date

August 2011

DOI

10.1038/ki.2011.49

Publisher

International Society of Nephrology. Published by Elsevier Inc.

Abstract

Erythropoiesis-stimulating agents (ESAs) are effective in ameliorating anemia in chronic kidney disease (CKD). A recent trial in diabetic patients with CKD, however, suggested a greater risk of stroke associated with full correction of anemia with ESAs. Using national Veterans Affairs data we performed a case–control study examining the association of incident ESA use with acute stroke in patients with estimated glomerular filtration rate <60cm3/min per 1.73m2 and outpatient hemoglobin <12g/dl. Using diagnosis codes, we identified 2071 acute hospitalized stroke cases and matched them 1:5 with controls without stroke, resulting in 12,426 total patients for analysis. Conditional logistic regression was used to estimate the association of ESA ...