Danger of Using EPO in CRAS Patients Suggested

March 10, 2014

Using erythropoietin (EPO) therapy in patients with cardio-renal-anemia syndrome may be associated with more harm than benefit in this population. As new study found a statistically higher mortality rate among EPO users.

Using erythropoietin (EPO) therapy in patients with cardio-renal-anemia syndrome (CRAS) may be associated with more harm than benefit in this population, a new study published in the Journal of Cardiac Failure suggests.

Cynthia Jackevicius, BScPhm, PharmD, BCPS, a professor at WesternU College of Pharmacy, and colleagues conducted a retrospective cohort study using administrative and clinical data from Veterans Affairs Greater Los Angeles Healthcare system patients from January 2003 to December 2006. The primary outcome was a composite of death, acute coronary syndromes (ACS), heart failure, and stroke. Multiple Cox regression modeling was used to evaluate the outcome in 213 patients prescribed EPO and 1,845 patients who were not.

"This study suggests caution in the use of EPO in patients with the combination of heart failure, chronic kidney disease and anemia," Jackevicius said in a statement. "Our study adds to prior research that similarly found increased risk of death and/or cardiovascular events with the use of EPO in patients of anemia and chronic kidney disease. While EPO may improve patient's blood counts for anemia, our study suggests this needs to be balanced against the potential harms of the medication that we found in this study."

Adjusted incidence of mortality was statistically significantly higher in EPO than non-EPO users (33.8% vs 19.7%; Hazard Ratio, 1.40; 95% Confidence Interval, 1.06-1.85; P = 0.02). In 18.8% of EPO patients and 10.8% of non-EPO patients, the researchers found documented crude ACS events, while stroke occurred in 22.5% and 18.3% of patients in the EPO and non-EPO groups, respectively.

The researchers recommend that clinicians considering EPO therapy in CRAS patients assess whether any potential benefits outweigh the risks of its use.


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