Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Kidney Int. 2011 Aug;80(3):288-94. doi: 10.1038/ki.2011.49. Epub 2011 Mar 9.
Erythropoiesis-stimulating agents (ESAs) are effective in ameliorating anemia in chronic kidney disease (CKD). A recent trial in diabetic patients with CKD, however, suggested a greater risk of stroke associated with full correction of anemia with ESAs. Using national Veterans Affairs data we performed a case-control study examining the association of incident ESA use with acute stroke in patients with estimated glomerular filtration rate < 60 cm³/min per 1.73 m² and outpatient hemoglobin <12 g/dl. Using diagnosis codes, we identified 2071 acute hospitalized stroke cases and matched them 1:5 with controls without stroke, resulting in 12,426 total patients for analysis. Conditional logistic regression was used to estimate the association of ESA use with stroke, adjusting for potential confounders. After multivariate adjustment, ESA use in 1026 patients was associated with greater odds of stroke (odds ratio 1.30). There was significant interaction between ESA use and cancer, with greater odds of stroke among ESA-treated cancer patients (odds ratio 1.85), but not in ESA-treated patients without cancer (odds ratio 1.07). ESA-treated patients with cancer received a median initial dose 2.5-4 times greater than ESA-treated patients without cancer, but pre-ESA hemoglobin and its rate of change did not differ between these groups. Hence, in a large national sample of anemic patients with CKD, ESA treatment was associated with an increased risk of acute stroke with the greatest effect among patients with cancer.
促红细胞生成素（Erythropoiesis-stimulating agents，ESAs）在改善慢性肾脏病（Chronic kidney disease，CKD）患者的贫血方面非常有效。然而，最近一项针对 CKD 合并糖尿病患者的试验表明，使用 ESAs 完全纠正贫血会增加卒中风险。本研究利用国家退伍军人事务部（Veterans Affairs）的数据进行了一项病例对照研究，旨在调查估算肾小球滤过率（estimated glomerular filtration rate，eGFR）<60 cm³/min/1.73m²且门诊血红蛋白（hemoglobin，Hb）<12 g/dl 的患者中，ESA 使用率与急性卒中之间的相关性。本研究通过诊断代码确定了 2071 例急性住院卒中病例，并按照 1:5 的比例与无卒中的对照组相匹配，共纳入 12426 例患者进行分析。使用条件逻辑回归估计了 ESA 使用与卒中之间的相关性，并对潜在混杂因素进行了调整。经过多变量调整后，1026 例患者使用 ESA 与卒中风险增加相关（比值比 1.30）。ESA 使用与癌症之间存在显著交互作用，在 ESA 治疗的癌症患者中，卒中风险更高（比值比 1.85），但在 ESA 治疗的非癌症患者中则不然（比值比 1.07）。ESA 治疗的癌症患者初始剂量中位数是 ESA 治疗非癌症患者的 2.5-4 倍，但两组患者的 ESA 前 Hb 及其变化率无差异。因此，在一项大型的、全国性的 CKD 贫血患者样本中，ESA 治疗与急性卒中风险增加相关，在癌症患者中风险最大。
