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Experimental Biology 2010: A Retrospective Study To Evaluate The Impact Of Erythropoietin Stimulating Agents On Cardiovascular Outcomes Independent Of Their Effect On Hemoglobin
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A Retrospective Study To Evaluate The Impact Of Erythropoietin Stimulating Agents On Cardiovascular Outcomes Independent Of Their Effect On Hemoglobin
C. Gandotra1, N. Koduri1, S. Loughlin2, M. Michael1, M.G. Daniel3, P. Sealy4, J. Diggs1, T. Mehta2; 1 Division of Cardiology, Howard University Hospital, Washington DC, DC 2 Department of Nephrology, Washington Hospital Center, Washington, DC 3 Center for Minority Health Services Research, Howard University, Washington, DC 4 Department of Internal Medicine, Howard University Hospital, Washington, DC
Purpose of Study: This retrospective cohort study was designed to examine if patients with chronic kidney disease who have received erythropoietin stimulating agents (ESA's)have an additional cardiovascular advantage compared to those who have not, despite having similar hemoglobin values in target range of 11-12 mg/dl. Methods Used: Charts of 480 patients from outpatient clinic data base of medstar health at Washington Hospital Center were reviewed. One hundred and sixteen (116) patients were identified with chronic kidney disease and anemia through this review of the electronic medical record. Forty three (43) patients received ESA’s and 73 were observed to have not been receiving ESA’s to achieve target Hb 11-12 mg/dl. Baseline demographic, clinical, and pertinent laboratory data were collected. The primary end point was defined as hospitalization for cardiovascular events including decompensated congestive heart failure, acute coronary syndrome (ACS), cerebrovascular accident and/ or transient ischemic accident. Patient records were searched for a mean duration of one and a half years to determine the occurrence of the primary endpoint. Summary of Results: There were 21 (28.8 percent) hospitalizations for cardiovascular events in patients who did not receive ESA and 8 (20 percent) hospitalizations for cardiovascular events in the ESA group (unadjusted p value 0.56). There were no deaths in either group during the study period. After multivariable analysis adjusting for baseline differences in medication use there was a relative risk reduction in hospitalizations in the ESA group by 62 percent compared to patients who did not receive ESA (RR 0.38; 95 % CI 0.16 – 0.94; p value <0.05). Conclusions: We conclude that the use of ESA’s decreases hospitalizations for cardiovascular adverse events in patients with chronic kidney disease (pre-dialysis) independent of their effect on hemoglobin and hematocrit.
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