Incidence of symptomatic stroke and cancer in chronic kidney disease patients treated with epoetins
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Use of erythropoiesis-stimulating agents (ESA) has been reported to increase the incidence of cardiovascular diseases at target Hb levels by more than 12.0 g/dl. The recent TREAT study found an increased incidence of stroke and cancer when maintaining the Hb level at 12.5 g/dl in diabetic patients.
Surveillance of Epoetin-Adverse Events of Stroke and Cancer (SEASCAN) was a cross-sectional study conducted under urgent conditions by the Committee on CKD Initiatives of the Japanese Society of Nephrology. Patients who were at least 18 years old and had CKD stage 4 and 5, namely, eGFR <30 ml/min/1.73 m2, and who had visited the outpatient department of the participating facilities between December 2009 and January 2010 with at least 6 months of prior medical treatment in the participating facilities were eligible to participate in the study.
Of 7,415 patients with CKD stage 4 and 5, 3,653 (49.3%), 879 (11.9%) and 2,883 (38.9%) patients received no epoetin, epoetin for less than 6 months and epoetin for at least 6 months, respectively. In patients who did not use epoetin, use of epoetin for less than 6 months and use of epoetin for at least 6 months, the numbers of patients with stroke were 38 (1.0%), 8 (0.9%) and 27 (0.9%), respectively, and those with newly diagnosed or exacerbated malignancy were 88 (2.4%), 30 (3.4%) and 71 (2.5%), respectively, demonstrating insignificant associations between outcome and duration of treatment with epoetin (P for trend = 0.666 in stroke and 0.836 in malignancy).
No significant increase in the risk of developing symptomatic stroke and cancer was observed for the use of epoetin in current clinical practice in Japan.
- Sliverberg, D, Wexler, D, Blum, M (2003) The cardio-renal-anemia syndrome: does it exist?. Nephrol Dial Transplant 18: pp. viii7-viii12
- Locatelli, F, Pisoni, RL, Combe, C, Bommer, J, Andreucci, VE, Piera, L (2004) Anaemia in haemodialysis patients of five European countries: association with morbidity and mortality in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 19: pp. 121-132 CrossRef
- Foley, RN, Parfrey, PS, Harnett, JD, Kent, GM, Murray, DC, Barre, PE (1996) The impact of anemia on cardiomyopathy, morbidity, and mortality in end-stage renal disease. Am J Kidney Dis 28: pp. 53-61 CrossRef
- Guideline for renal anemia in chronic kidney disease. Japanese of Japanese Society for Dialysis Therapy 41: pp. 661-716 CrossRef
- European best practice guideline for the management of anemia in patients with chronic renal failure. Nephrol Dial Transplant 19: pp. S1-S47
- Clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease. Am J Kidney Dis 47: pp. S1-S144
- Pfeffer, MA, Burdmann, EA, Chen, CY, Cooper, ME, Zeeuw, D, Eckardt, KU (2009) A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med 361: pp. 2019-2032 CrossRef
- Imai, E, Horio, M, Watanabe, T, Iseki, K, Yamagata, K, Hara, S (2009) Prevalence of chronic kidney disease in the Japanese general population. Clin Exp Nephrol 13: pp. 621-630 CrossRef
- Matsuo, S, Imai, E, Horio, M (2009) Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 53: pp. 982-992 CrossRef
- Cuzick, J (1985) A Wilcoxon-type test for trend. Stat Med 4: pp. 87-90 CrossRef
- Prevalence of stroke in Japanese general population. http://www.mhlw.go.jp/toukei/kouhyo/data-kou18/data12/junkan-h12-2.pdf. Accessed 25 April 2010.
- Kokubo, Y, Nakamura, S, Okamura, T, Yoshimasa, Y, Makino, H, Watanabe, M (2009) Relationship between blood pressure category and incidence of stroke and myocardial infarction in an urban Japanese population with and without chronic kidney disease: the Suita Study. Stroke 40: pp. 2674-2679 CrossRef
- Inoue, R, Ohkubo, T, Kikuya, M, Metoki, H, Asayama, K, Kanno, A (2009) Stroke risk of blood pressure indices determined by home blood pressure measurement: the Ohasama study. Stroke 40: pp. 2859-2861 CrossRef
- Singh, AK, Szczech, L, Tang, KL, Barnhart, H, Sapp, S, Wolfson, M (2006) Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med 355: pp. 2085-2098 CrossRef
- Drüeke, TB, Locatelli, F, Clyne, N, Eckardt, KU, Macdougall, IC, Tsakiris, D (2006) Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med 355: pp. 2071-2084 CrossRef
- Eschbach, JW, Abdulhadi, MH, Browne, JK, Delano, BG, Downing, MR, Egrie, JC (1989) Recombinant human erythropoietin in anemic patients with end-stage renal disease. Results of a phase III multicenter clinical trial. Ann Intern Med 111: pp. 992-1000
- Association between recombinant human erythropoietin and quality of life and exercise capacity of patients receiving haemodialysis. Br Med J 300: pp. 573-578 CrossRef
- Szczech, LA, Barnhart, HX, Inrig, JK, Reddan, DN, Sapp, S, Califf, RM (2008) Secondary analysis of the CHOIR trial epoetin-alpha dose and achieved hemoglobin outcomes. Kidney Int 74: pp. 791-798 CrossRef
- Hirakata, H, Tsubakihara, Y, Gejyo, F, Nishi, S, Iino, Y, Watanabe, Y (2010) Maintaining high hemoglobin levels improved the left ventricular mass index and quality of life scores in pre-dialysis Japanese chronic kidney disease patients. Clin Exp Nephrol 14: pp. 28-35 CrossRef
- Incidence of symptomatic stroke and cancer in chronic kidney disease patients treated with epoetins
Clinical and Experimental Nephrology
Volume 14, Issue 5 , pp 445-452
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- Renal anemia
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- Author Affiliations
- 1. Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
- 2. Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Box B6, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
- 3. Department of Nephrology, Saitama Medical University, Saitama, Japan
- 4. Third Department of Medicine, Fukushima Medical College, Fukushima, Japan