Are Erythropoiesis Stimulating Agents toxic?
Erythropoiesis Stimulating Agents are administered to more than 95% of patients receiving dialysis in the United States.
Like any other pharmacologic agent, ESAs have risks that must be weighed against their benefits.
The most compelling benefit of ESA therapy is transfusion avoidance. A pre- versus posttreatment QOL benefit of ESA therapy was reported in patients receiving dialysis whose baseline Hb in the pre-ESA era was 7–8 g/dL, and the Hb level was increased with ESA to 10–11 g/dL; however, no significant QOL benefit has been shown in the RCTs comparing Hb targets of 9–11.5 and 13–15 g/dL. None of the randomized clinical trials of ESA therapy has ever shown a mortality benefit
Data demonstrating an improvement in the rates of stroke, venous thromboembolism, and heart failure (but not mortality) among dialysis patients following a reduction in mean Hb levels from a change in ESA reimbursement also suggest that ESAs and/or higher Hb levels have adverse effects in this vulnerable population.
