Clinical outcomes of erythropoietin use in heart failure patients with anemia of chronic kidney disease

Background — Anemia and chronic kidney disease are common disorders in heart failure (HF) patients, and are associated with increased morbidity and mortality. This study assesses clinical outcomes associated with erythropoietin (EPO) treatment in this cardio-renal-anemia syndrome (CRAS) population.

Methods and Results — This is a retrospective cohort study of VA patients with CRAS from January 2003 to December 2006. The primary outcome was a composite of death, acute coronary syndromes, HF and stroke. Multiple Cox regression modeling was used to evaluate the outcome in patients prescribed (n=213) and not prescribed EPO (n=1845). Adjusted incidence of mortality was statistically significantly higher in EPO than non-EPO users (33.8% vs. 19.7%; HR: 1.40; 95% CI 1.06–1.85, p=0.02). The unadjusted composite of cardiovascular events/death was higher in the EPO group, but not statistically significant when adjusted for confounders (p=0.12). Crude ACS events were documented in 18.8% and 10.8% patients (p=0.001), and stroke events occurred in 22.5% and 18.3% patients (p=0.14) in EPO and non-EPO groups, respectively.

Conclusions — The authors found that in CRAS patients, EPO use was associated with increased risk of mortality and a trend towards increased cardiovascular events. Therefore, clinicians considering EPO use in CRAS patients should assess whether any potential benefits outweigh the risks of use.