Erythropoietin use and the risk of stroke in patients on hemodialysis: A retrospective cohort study in Taiwan

TY - JOUR

T1 - Erythropoietin use and the risk of stroke in patients on hemodialysis

T2 - A retrospective cohort study in Taiwan

AU - Hung, Peir Haur

AU - Yeh, Chih Ching

AU - Hsiao, Chih Yen

AU - Muo, Chih Hsin

AU - Hung, Kuan Yu

AU - Tsai, Kuen Jer

N1 - Funding Information: This study was supported in part by Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW 109-TDU-B212-114004), China Medical University Hospital, Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10701010021), and NRPB Stroke Clinical Trial Consortium (MOST 109-2321-B-039-002). Publisher Copyright: © 2021 The Authors.

PY - 2021/7/20

Y1 - 2021/7/20

N2 - BACKGROUND: Targeting higher hemoglobin levels with erythropoietin to treat anemia in patients with chronic kidney disease is associated with increased cardiovascular risk, including that of stroke. The risks of the subtypes of stroke, ischemic, hemorrhagic, and unspecified, following the administration of erythropoietin in patients with end-stage renal disease receiving hemodialysis remain unclear. METHODS AND RESULTS: Overall, 12 948 adult patients with end-stage renal disease treated during 1999 to 2010 who had undergone hemodialysis were included. The study end points were the incidences of stroke and its subtypes. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) of stroke and its subtypes in erythropoietin recipients compared with nonrecipients. Patients in the erythropoietin cohort did not have an increased risk of stroke compared with those in the nonerythropoietin cohort (adjusted HR, 1.03; 95% CI, 0.92–1.15). Compared with patients in the nonerythropoietin cohort, the risks of ischemic, hemorrhagic, or unspecified stroke were not higher in patients in the erythropoietin cohort (adjusted HRs, 1.08 [95% CI, 0.93–1.26], 0.96 [95% CI, 0.78–1.18], and 1.03 [95% CI, 0.80–1.32], respectively). Increased risks of stroke and its subtypes were not observed with even large annual defined daily doses of erythropoietin (>201). CONCLUSIONS: Erythropoietin in patients receiving hemodialysis is not associated with increased risk of stroke or any of its subtypes.

AB - BACKGROUND: Targeting higher hemoglobin levels with erythropoietin to treat anemia in patients with chronic kidney disease is associated with increased cardiovascular risk, including that of stroke. The risks of the subtypes of stroke, ischemic, hemorrhagic, and unspecified, following the administration of erythropoietin in patients with end-stage renal disease receiving hemodialysis remain unclear. METHODS AND RESULTS: Overall, 12 948 adult patients with end-stage renal disease treated during 1999 to 2010 who had undergone hemodialysis were included. The study end points were the incidences of stroke and its subtypes. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) of stroke and its subtypes in erythropoietin recipients compared with nonrecipients. Patients in the erythropoietin cohort did not have an increased risk of stroke compared with those in the nonerythropoietin cohort (adjusted HR, 1.03; 95% CI, 0.92–1.15). Compared with patients in the nonerythropoietin cohort, the risks of ischemic, hemorrhagic, or unspecified stroke were not higher in patients in the erythropoietin cohort (adjusted HRs, 1.08 [95% CI, 0.93–1.26], 0.96 [95% CI, 0.78–1.18], and 1.03 [95% CI, 0.80–1.32], respectively). Increased risks of stroke and its subtypes were not observed with even large annual defined daily doses of erythropoietin (>201). CONCLUSIONS: Erythropoietin in patients receiving hemodialysis is not associated with increased risk of stroke or any of its subtypes.

KW - End-stage renal disease

KW - Erythropoietin

KW - Hemodialysis

KW - Ischemic stroke

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U2 - 10.1161/JAHA.120.019529

DO - 10.1161/JAHA.120.019529

M3 - Article

C2 - 34176302

AN - SCOPUS:85111595009

SN - 2047-9980

VL - 10

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

IS - 14

M1 - e019529

ER -