Hypertension following erythropoietin (EPO) in chronic kidney disease
- Wajeh Y Qunibi, MD
Wajeh Y Qunibi, MD
- Professor of Medicine
- University of Texas Health Sciences Center
- William L Henrich, MD, MACP
William L Henrich, MD, MACP
- University of Texas Health Science Center at San Antonio
- Section Editors
- Steve J Schwab, MD
Steve J Schwab, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- University of Tennessee Health Science Center
- George L Bakris, MD
George L Bakris, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Professor of Medicine
- The University of Chicago
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 erythropoietin [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 intravenously for the anemia of CKD develop an elevation in diastolic pressure of 10 mmHg or more [4,5]. Much of the evidence that erythropoietin 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 erythropoietin versus placebo or no erythropoietin (n = 387 patients), patients who did not receive erythropoietin 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 nondialysis CKD patients showed a 26 percent higher risk of hypertension in erythropoietin-treated patients, compared with no erythropoietin or placebo, but the effect was not statistically significant .
Putative risk factors for erythropoiesis-stimulating agent (ESA)-associated hypertension include the following:
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