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Effect of Erythropoiesis-Stimulating Agents on Blood Pressure in Pre-Dialysis Patients

INTRODUCTION: Erythropoiesis-Stimulating Agents (ESA) are hypothesized to increase cardiovascular mortality in patients with chronic kidney disease. One of the proposed mechanisms is the elevation of blood pressure (BP) by ESA. Therefore, we aimed to determine whether the use of ESA was associated w...

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Autores principales: Suttorp, Marit M., Hoekstra, Tiny, Mittelman, Moshe, Ott, Ilka, Franssen, Casper F. M., Dekker, Friedo W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3877353/
https://www.ncbi.nlm.nih.gov/pubmed/24391978
http://dx.doi.org/10.1371/journal.pone.0084848
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author Suttorp, Marit M.
Hoekstra, Tiny
Mittelman, Moshe
Ott, Ilka
Franssen, Casper F. M.
Dekker, Friedo W.
author_facet Suttorp, Marit M.
Hoekstra, Tiny
Mittelman, Moshe
Ott, Ilka
Franssen, Casper F. M.
Dekker, Friedo W.
author_sort Suttorp, Marit M.
collection PubMed
description INTRODUCTION: Erythropoiesis-Stimulating Agents (ESA) are hypothesized to increase cardiovascular mortality in patients with chronic kidney disease. One of the proposed mechanisms is the elevation of blood pressure (BP) by ESA. Therefore, we aimed to determine whether the use of ESA was associated with antihypertensive treatment and higher BP. MATERIALS AND METHODS: In this cohort 502 incident pre-dialysis patients were included who started specialized pre-dialysis care in 25 clinics in the Netherlands. Data on medication including ESA use and dose, co-morbidities and BP were routinely collected every 6 months. Antihypertensive treatment and BP were compared for patients with and without ESA at baseline. Differences in antihypertensive medication and BP during pre-dialysis care were estimated with linear mixed models adjusted for age, sex, body mass index, cardiovascular disease, diabetes mellitus and estimated glomerular filtration rate. RESULTS: At baseline, 95.6% of patients with ESA were treated with antihypertensive medication and 73.1% of patients without ESA. No relevant difference in BP was found. During pre-dialysis care patients with ESA used 0.77 (95% CI 0.63;0.91) more classes of antihypertensive drugs. The adjusted difference in systolic blood pressure (SBP) was −0.3 (95% CI −2.7;2.0) mmHg and in diastolic blood pressure (DBP) was −1.0 (95% CI −2.1;0.3) mmHg for patients with ESA compared to patients without ESA. Adjusted SBP was 3.7 (95% CI −1.6;9.0) mmHg higher in patients with a high ESA dose compared to patients with a low ESA dose. CONCLUSIONS: Our study confirms the hypertensive effect of ESA, since ESA treated patients received more antihypertensive agents. However, no relevant difference in BP was found between patients with and without ESA, thus the increase in BP seems to be controlled for by antihypertensive medication.
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spelling pubmed-38773532014-01-03 Effect of Erythropoiesis-Stimulating Agents on Blood Pressure in Pre-Dialysis Patients Suttorp, Marit M. Hoekstra, Tiny Mittelman, Moshe Ott, Ilka Franssen, Casper F. M. Dekker, Friedo W. PLoS One Research Article INTRODUCTION: Erythropoiesis-Stimulating Agents (ESA) are hypothesized to increase cardiovascular mortality in patients with chronic kidney disease. One of the proposed mechanisms is the elevation of blood pressure (BP) by ESA. Therefore, we aimed to determine whether the use of ESA was associated with antihypertensive treatment and higher BP. MATERIALS AND METHODS: In this cohort 502 incident pre-dialysis patients were included who started specialized pre-dialysis care in 25 clinics in the Netherlands. Data on medication including ESA use and dose, co-morbidities and BP were routinely collected every 6 months. Antihypertensive treatment and BP were compared for patients with and without ESA at baseline. Differences in antihypertensive medication and BP during pre-dialysis care were estimated with linear mixed models adjusted for age, sex, body mass index, cardiovascular disease, diabetes mellitus and estimated glomerular filtration rate. RESULTS: At baseline, 95.6% of patients with ESA were treated with antihypertensive medication and 73.1% of patients without ESA. No relevant difference in BP was found. During pre-dialysis care patients with ESA used 0.77 (95% CI 0.63;0.91) more classes of antihypertensive drugs. The adjusted difference in systolic blood pressure (SBP) was −0.3 (95% CI −2.7;2.0) mmHg and in diastolic blood pressure (DBP) was −1.0 (95% CI −2.1;0.3) mmHg for patients with ESA compared to patients without ESA. Adjusted SBP was 3.7 (95% CI −1.6;9.0) mmHg higher in patients with a high ESA dose compared to patients with a low ESA dose. CONCLUSIONS: Our study confirms the hypertensive effect of ESA, since ESA treated patients received more antihypertensive agents. However, no relevant difference in BP was found between patients with and without ESA, thus the increase in BP seems to be controlled for by antihypertensive medication. Public Library of Science 2013-12-31 /pmc/articles/PMC3877353/ /pubmed/24391978 http://dx.doi.org/10.1371/journal.pone.0084848 Text en © 2013 Suttorp et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Suttorp, Marit M.
Hoekstra, Tiny
Mittelman, Moshe
Ott, Ilka
Franssen, Casper F. M.
Dekker, Friedo W.
Effect of Erythropoiesis-Stimulating Agents on Blood Pressure in Pre-Dialysis Patients
title Effect of Erythropoiesis-Stimulating Agents on Blood Pressure in Pre-Dialysis Patients
title_full Effect of Erythropoiesis-Stimulating Agents on Blood Pressure in Pre-Dialysis Patients
title_fullStr Effect of Erythropoiesis-Stimulating Agents on Blood Pressure in Pre-Dialysis Patients
title_full_unstemmed Effect of Erythropoiesis-Stimulating Agents on Blood Pressure in Pre-Dialysis Patients
title_short Effect of Erythropoiesis-Stimulating Agents on Blood Pressure in Pre-Dialysis Patients
title_sort effect of erythropoiesis-stimulating agents on blood pressure in pre-dialysis patients
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3877353/
https://www.ncbi.nlm.nih.gov/pubmed/24391978
http://dx.doi.org/10.1371/journal.pone.0084848
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