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Clinical Trial
. 2013 Dec 31;8(12):e84848.
doi: 10.1371/journal.pone.0084848. eCollection 2013.

Effect of erythropoiesis-stimulating agents on blood pressure in pre-dialysis patients

Marit M Suttorp  1 , Tiny Hoekstra  1 , Moshe Mittelman  2 , Ilka Ott  3 , Casper F M Franssen  4 , Friedo W Dekker  1
Affiliations
Clinical Trial

Effect of erythropoiesis-stimulating agents on blood pressure in pre-dialysis patients

Marit M Suttorp et al. PLoS One. .

Abstract

Introduction: Erythropoiesis-Stimulating Agents (ESA) are hypothesized to increase cardiovascular mortality in patients with chronic kidney disease. One of the proposed mechanisms is the elevation of blood pressure (BP) by ESA. Therefore, we aimed to determine whether the use of ESA was associated with antihypertensive treatment and higher BP.

Materials and methods: In this cohort 502 incident pre-dialysis patients were included who started specialized pre-dialysis care in 25 clinics in the Netherlands. Data on medication including ESA use and dose, co-morbidities and BP were routinely collected every 6 months. Antihypertensive treatment and BP were compared for patients with and without ESA at baseline. Differences in antihypertensive medication and BP during pre-dialysis care were estimated with linear mixed models adjusted for age, sex, body mass index, cardiovascular disease, diabetes mellitus and estimated glomerular filtration rate.

Results: At baseline, 95.6% of patients with ESA were treated with antihypertensive medication and 73.1% of patients without ESA. No relevant difference in BP was found. During pre-dialysis care patients with ESA used 0.77 (95% CI 0.63;0.91) more classes of antihypertensive drugs. The adjusted difference in systolic blood pressure (SBP) was -0.3 (95% CI -2.7;2.0) mmHg and in diastolic blood pressure (DBP) was -1.0 (95% CI -2.1;0.3) mmHg for patients with ESA compared to patients without ESA. Adjusted SBP was 3.7 (95% CI -1.6;9.0) mmHg higher in patients with a high ESA dose compared to patients with a low ESA dose.

Conclusions: Our study confirms the hypertensive effect of ESA, since ESA treated patients received more antihypertensive agents. However, no relevant difference in BP was found between patients with and without ESA, thus the increase in BP seems to be controlled for by antihypertensive medication.

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Conflict of interest statement

Competing Interests: Furthermore, the PREPARE-2 study was funded by the Dutch Kidney Foundation and, indeed, an unrestricted grant from Amgen. This work was supported by the FP7-Health European commission EpoCan grant. None of the sponsors were involved in study design, collection of data, statistical analyses, interpretation of data, writing of the manuscript, or in the decision to submit the paper for publication. It therefore does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Distribution of systolic and diastolic blood pressure at baseline.
The distribution of SBP and DBP are presented for the total population and stratified by ESA use. The total percentage of patients within the blood pressure target (DBP: 80 mmHg and SBP: 130 mmHg) are depicted in the histogram. Abbreviations: ESA = Erythropoiesis-Stimulating Agent, SBP = Systolic Blood Pressure, DBP = Diastolic Blood Pressure.
See this image and copyright information in PMC

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