Blog entry by Meguid El Nahas
In this paper by Seliger and colleagues from Baltimore USA, the authors report an increased risk of stroke in CKD (mainly 3) who are using ESAs. This observational study of 12,426 patients individuals confirmed the previous observation made in diabetic CKD patients treated with Darbopoietin alpha (the TREAT study). The current report highlights the fact that high dose of ESAs are associated with significantly increased risk of stroke in patients with a history of cancer (under active treatment) and those with a previous history of stroke. A posthoc analysis of the TREAT study showed increased risk in those who failed to respond to Darbopoietin raising the suspicion that it may be the high dose of ESA rather than the acheived Hb level that is associated with increased complications; strokes and cancer. The observation by Seliger and colleagues reinforces the FDA recommendations that Darbepoietin alpha and epoietin alpha should be prescribed at the lowest possible dose to achieve the lowest Hb level. Whether these agents should be used at all in patients with a history of cancer or stroke is very much questionable.