Published December 3rd, 2013 in the Annals of Internal Medicine, the American College of Physicians (ACP), recommended against using Erythropoiesis-Stimulating Agents (ESAs), commonly referred to as "EPO," in patients with mild to moderate anemia and Congestive Heart Failure or Coronary Artery Disease. The harms outweigh the benefits because they cause an increased risks of thromboembolic (blood vessel clotting) events and stroke rates. This should be taken as major news for those with Chronic Kidney Disease (CKD) since both Cardiovascular Disease and Anemia are common challenges in the CKD Community.
Recommended Reading: Why EPO Can Be Harmful to Individuals Suffering with Chronic Kidney Disease
According to Davita Health Care Partners, Cardiovascular Disease is common in people with CKD "regardless of age, stage of kidney disease or if they’ve had a transplant." Additionally, several studies have revealed that anemia can be related to Cardiovascular Disease such as Coronary Artery Disease because the lack of kidney function prevents Erythropoietin from creating red blood cells. Fewer red blood cells mean less oxygen goes to the body’s tissues and organs such as the heart which can induce a heart attack. Anemia, present in approximately 10% to 20% percent of individuals with Coronary Artery Disease, can substantially worsen CKD patients' outcomes, increase risk of hospitalization, decrease exercise capacity, and lead to a poor quality of life generally.
Recommended Reading: Increased Transfusion among CKD Individuals, Troubling Trend
As an alternative solution to anemia, aside from ESAs (Aranesp, Epogen, and Procrit), the ACP's new guidelines reveal that "Transfusion may benefit patients with lower hemoglobin levels, less than 7 - 8 g/dL, but the evidence suggests that red blood cell transfusion for milder anemia in patients with heart disease does not improve mortality," said Dr. Molly Cooke, President of the ACP. Further, emerging evidence shows a short term benefit of intravenous (IV) iron in patients, but ACP found evidence lacking on long-term outcomes.
Researchers further suggest that limiting ESAs and creating "More modest hemoglobin targets" may improve the quality of life for patients with mild to moderate anemia and heart disease including those with CKD.
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Hanks, Megan. "ACP Recommends Tighter Transfusion Strategy to Treat Anemia in Patients with Heart Disease." Http://www.eurekalert.org/. American College of Physicians.
Qaseem A, Humphrey LL, Fitterman N, Starkey M, Shekelle P, Clinical Guidelines Committee of the American College of P. Treatment of anemia in patients with heart disease: a clinical practice guideline from the american college of physicians. Ann Intern Med 2013,159:770-779.
Carson JL, Grossman BJ, Kleinman S, Tinmouth AT, Marques MB, Fung MK, et al. Red blood cell transfusion: a clinical practice guideline from the AABB*. Ann Intern Med 2012,157:49-58.
"New Anemia Treatment Guidelines for Patients with Heart Disease « Transfusion News."Http://transfusionnews.com/. Wiley Blackwell.
Husten, Larry. "New Guideline Recommends Conservative Treatment for Heart Patients with Anemia." Forbes. Forbes Magazine