Effect of erythropoiesis-stimulating agents on blood pressure in pre-dialysis patients.

<h4>Introduction</h4>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 E...

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Autores principales:	Marit M Suttorp, Tiny Hoekstra, Moshe Mittelman, Ilka Ott, Casper F M Franssen, Friedo W Dekker
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/34409735585944028ae8e302ec2f915c
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spelling	oai:doaj.org-article:34409735585944028ae8e302ec2f915c2021-11-18T08:39:17ZEffect of erythropoiesis-stimulating agents on blood pressure in pre-dialysis patients.1932-620310.1371/journal.pone.0084848https://doaj.org/article/34409735585944028ae8e302ec2f915c2013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24391978/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Introduction</h4>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.<h4>Materials and methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.Marit M SuttorpTiny HoekstraMoshe MittelmanIlka OttCasper F M FranssenFriedo W DekkerPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 12, p e84848 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Marit M Suttorp Tiny Hoekstra Moshe Mittelman Ilka Ott Casper F M Franssen Friedo W Dekker Effect of erythropoiesis-stimulating agents on blood pressure in pre-dialysis patients.
description	<h4>Introduction</h4>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.<h4>Materials and methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.
format	article
author	Marit M Suttorp Tiny Hoekstra Moshe Mittelman Ilka Ott Casper F M Franssen Friedo W Dekker
author_facet	Marit M Suttorp Tiny Hoekstra Moshe Mittelman Ilka Ott Casper F M Franssen Friedo W Dekker
author_sort	Marit M Suttorp
title	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_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_sort	effect of erythropoiesis-stimulating agents on blood pressure in pre-dialysis patients.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/34409735585944028ae8e302ec2f915c
work_keys_str_mv	AT maritmsuttorp effectoferythropoiesisstimulatingagentsonbloodpressureinpredialysispatients AT tinyhoekstra effectoferythropoiesisstimulatingagentsonbloodpressureinpredialysispatients AT moshemittelman effectoferythropoiesisstimulatingagentsonbloodpressureinpredialysispatients AT ilkaott effectoferythropoiesisstimulatingagentsonbloodpressureinpredialysispatients AT casperfmfranssen effectoferythropoiesisstimulatingagentsonbloodpressureinpredialysispatients AT friedowdekker effectoferythropoiesisstimulatingagentsonbloodpressureinpredialysispatients
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Effect of erythropoiesis-stimulating agents on blood pressure in pre-dialysis patients.

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