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drug adverse effects of erythropoiesis-stimulating agents

Adverse effects: 1) chronic kidney disease a) increase in death & cardiovascular events when used to increase hemoglobin above 11 g/dL [3,5]; (initial report 12 g/dL) or history of stroke [5] - ref [2] does not confirm b) increased risk of thrombosis risk [1,2] c) increased risk of stroke [1,2] HR= 1.51 d) increased risk or worsening of hypertension [2] e) probably increases risks for death,cardiovascular events, & end-stage renal disease [2] f) progression of chronic renal failure [4] 2) cancer a) erythropoiesis-stimulating agents & cancer are both associated with an increased risk of thrombosis [6] b) may shorten survival & time to tumor progression of some cancers when used in high doses & increase mortality [5] c) may be growth signal 3) surgery - increased risk of deep vein thrombosis after orthopedic surgery in some patients

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DRUGS: erythropoiesis-stimulating agent FORM: drug adverse effects erythropoiesis stimulating agent

References

  1. Prescriber's Letter 14(6): 2007 Safe Use of Erythropoiesis-Stimulating Agents (ESAs) Detail-Document#: 230607 (subscription needed) http://www.prescribersletter.com
  2. Palmer SC, Navaneethan SD, Craig JC, et al. Meta-analysis: Erythropoiesis-stimulating agents in patients with chronic kidney disease. Ann Intern Med July 6, 2010; 153(1):53-55. PMID: 20439566
  3. FDA MedWatch: 06/25/2011 Erythropoiesis-Stimulating Agents (ESAs) In Chronic Kidney Disease: Drug Safety Communication - Modified Dosing Recommendations http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm260641.htm
  4. Inrig JK et al. Effect of hemoglobin target on progression of kidney disease: A secondary analysis of the CHOIR (Correction of Hemoglobin and Outcomes in Renal Insufficiency) trial. Am J Kidney Dis 2012 Sep; 60:390 PMID: 22537421
  5. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 19 American College of Physicians, Philadelphia 2012, 2015, 2022
  6. Bohlius J, Bohlke K, Castelli R et al. Management of cancer-associated anemia with erythropoiesis-stimulating agents: ASCO/ASH clinical practice guideline update. Blood Adv 2019 Apr 23; 3:1197 PMID: 30971397 Free PMC Article http://www.bloodadvances.org/content/3/8/1197