Hypertension is a common adverse effect of erythropoietin (EPO) treatment that is observed among patients with chronic kidney disease (CKD) and even among healthy subjects who receive EPO [1-3].
This topic reviews hypertension related to erythropoietin among CKD patients. Other issues related to erythropoietin among CKD patients, including hemoglobin (Hb) targets, are addressed elsewhere. (See "Erythropoietin for the anemia of chronic kidney disease among predialysis and peritoneal dialysis patients" and "Erythropoietin for the anemia of chronic kidney disease in hemodialysis patients" and "Anemia of chronic kidney disease: Target hemoglobin/hematocrit for patients treated with erythropoietic agents".)
EPIDEMIOLOGY AND RISK FACTORS
Approximately 20 to 30 percent of patients who receive erythropoietin (EPO) intravenously for the anemia of chronic kidney disease (CKD) develop an elevation in diastolic pressure of 10 mmHg or more [4,5]. Much of the evidence that EPO contributes to hypertension in CKD patients is from a series of meta-analyses [5,6]. As an example, in one meta-analysis that included six randomized trials comparing EPO versus placebo or no EPO (n = 387 patients), patients who did not receive EPO had a lower risk of hypertension (relative risk [RR] 0.50, 95% CI 0.33-0.76).
Another meta-analysis from the Cochrane Collaboration that included four controlled trials in non-dialysis CKD patients showed a 26 percent higher risk of hypertension in EPO-treated patients compared with no EPO or placebo, but the effect was not statistically significant .
Putative risk factors for ESA-associated hypertension include the following: