Abstract 206: Cerebrovascular Events In Patients With Chronic Kidney Disease On Erythropoiesis Stimulating Agent
Title: Cerebrovascular Events in Patients with Chronic Kidney Disease on Erythropoiesis Stimulating
Authors: Ali M Rad, MD, MPH; Shubham Misra,MD;Rajan Garg, MD;Karine Karapetyan, MD;Sheila Roxana Safar, MD; Daniel Goldsmith, MD
Background: Anemia is associated with an increased risk of cardiovascular events among patients with Chronic Kidney Disease (CKD). Guidelines have been developed for hemoglobin (Hgb) targets. Erythropoietin Stimulating Agents (ESA) are commonly used to increase hemoglobin level in CKD patients. The recent TREAT study found an increased incidence of stroke and cancer when maintaining the Hgb level at 12.5 g/dl. In the opposite, Watanabe et al showed no significant increase in risk of developing stroke in a Japanese population.
Methods: All patients with chronic kidney disease who admitted between Jan 2009 till June 2011 were selected. Patients are categorized to 2 groups, CKD patients with cerebravascular events and CKD with no cerebrovascular events. Binary logistic regression was used for analysis. All results were adjusted for age and gender.
Results: A total of 4926 patients were recognized. 348 out of 4926 had cerebrovascular events in their admissions between Jan 2009 till June 2011. 241/341 had ischemic cerebrovascular events, and the remainder had hemorrhagic events. Using binary logistic regression, our study shows a significant association between ESA injections and cerebrovascular events after adjusting for age, sex and Hgb level (p < 0.001).
Conclusions: We showed there is significant association between ESA use and cerebrovascular events adjusting for hemoglobin level, age and sex. Even though there was association between Hgb level and cerebrovascular events in our preliminary data, after adjusting for ESA injections, there was no association between Hgb level and cerebrovascular events. This suggests less of an association between Hgb level and stroke than use of an ESA and stroke. Based on these results, we recommend considering iron replacement and blood transfusion in the treatment of anemia and CKD. More studies should be done to establish possible causation and pathophysiology between ESA injections and cerebrovascular agents which may include evaluating for any dose related association.
- © 2012 by American Heart Association, Inc.