Erythropoietin and resistant hypertension in CKD

• Published in: Seminars in nephrology Vol. 34; no. 5; p. 540
• Main Authors: Boyle, Suzanne M, Berns, Jeffrey S
• Format: Journal Article
• Language: English
• Published: United States 01.09.2014
• Subjects: Anemia - complications; Anemia - drug therapy; Anemia - physiopathology; Blood Pressure - drug effects; Drug Resistance; Endothelin-1 - metabolism; Erythropoietin - adverse effects; Hematinics - adverse effects; Humans; Hypertension - chemically induced; Hypertension - physiopathology; Nitric Oxide - metabolism; Recombinant Proteins - adverse effects; Renal Insufficiency, Chronic - complications; Renin-Angiotensin System - physiology; chronic kidney disease; Erythropoietin-stimulating agents; hypertension; anemia
• ISSN: 1558-4488
• DOI: 10.1016/j.semnephrol.2014.08.008

There is a well-documented association between erythropoiesis-stimulating agents (ESAs) and hypertension in chronic kidney disease. Studies suggest that the mechanism for this is multifactorial. First, some chronic kidney disease patients may have a limited ability to accommodate a rapid increase in red cell volume because of a decreased glomerular filtration rate, left ventricular hypertrophy, and decreased arterial compliance. Second, there is likely a direct vasoconstrictor effect of ESAs. Although no large randomized controlled trials of ESAs have been designed with blood pressure as an a priori outcome, several meta-analyses have explored this relationship and generally support the existence of ESA-induced hypertension. There are as of yet no data directly linking ESA-induced hypertension with increased cardiovascular morbidity and mortality. Despite this, clinicians should be vigilant for ESA-induced hypertension, use caution when using ESAs in patients with resistant hypertension, and be attentive to the rate of hemoglobin increase in patients with poorly controlled blood pressure.