Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Medicine, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv, Israel.
PLoS One. 2013 Dec 31;8(12):e84848. doi: 10.1371/journal.pone.0084848. eCollection 2013.
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.
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.
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.
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.
促红细胞生成素刺激剂（ESA）被认为会增加慢性肾脏病患者的心血管死亡率。其中一个提出的机制是 ESA 升高血压（BP）。因此，我们旨在确定 ESA 的使用是否与降压治疗和更高的 BP 相关。
本队列纳入了 502 例新进入透析前的患者，这些患者在荷兰的 25 个诊所开始接受专门的透析前护理。定期每 6 个月收集包括 ESA 使用和剂量、合并症和 BP 在内的药物数据。在基线时比较了有和没有 ESA 的患者的降压治疗和 BP。在透析前护理期间，使用线性混合模型调整年龄、性别、体重指数、心血管疾病、糖尿病和估计肾小球滤过率来估计降压药物和 BP 的差异。
在基线时，95.6%的 ESA 患者接受了降压药物治疗，73.1%的无 ESA 患者接受了降压药物治疗。未发现 BP 存在显著差异。在透析前护理期间，ESA 患者使用了 0.77（95%CI 0.63；0.91）种更多类别的降压药物。与无 ESA 患者相比，ESA 患者的收缩压（SBP）调整差异为-0.3（95%CI -2.7；2.0）mmHg，舒张压（DBP）调整差异为-1.0（95%CI -2.1；0.3）mmHg。与低 ESA 剂量患者相比，高 ESA 剂量患者的调整 SBP 高 3.7（95%CI -1.6；9.0）mmHg。
我们的研究证实了 ESA 的降压作用，因为 ESA 治疗的患者接受了更多的降压药物。然而，有和没有 ESA 的患者之间的 BP 没有显著差异，因此 BP 的升高似乎通过降压药物得到了控制。
