Complications of EPO Use

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Well, I had hoped to be more of an active blogger during my holiday vacation this year, but my internet access has been much spottier than desired way out in the boondocks of Western France (not that I expect any renal fellows stuck in the hospital to be sympathetic to my plight in the slightest…) I’ll post when I can:

Here’s a list of some complications of erythropoietin use:

1. Increased thrombotic events. As the CHOIR study and others have now convincingly shown, elevated hemoglobin targets in CKD/ESRD patients are associated with an increased risk of cardiovascular events (the CHOIR study in particular demonstrated a hazard ratio of 1.34 in CKD patients randomized to a high Hgb target compared to a lower Hgb target, using a composite endpoint of death, MI, CHF requiring hospitalization, and stroke).

2. Hypertension: Patients may even experience intradialytic hypertension after receiving erythropoietin.

3. AV graft thrombosis: again, this correlates with the first point, that elevated Hgb concentrations can result in increased thrombotic events.

4. Pure red cell aplasia: rarely, patients can develop anti-EPO antibodies that result in pure red cell aplasia; this was predominantly associated with a form of EPO (Eprex) not marketed within the U.S.

5. Seizures: via a mechanism that appears uncertain.

6. Progression of diabetic proliferative retinopathy: because EPO has some angiogenic activity, it has been suggested to cause worsening of diabetic retinopathy, with some clinical studies appearing to confirm this hypothesis.


  1. Great post. Thanks for the quick review. Incidence of fatal and non-fatal CVA in TREAT Trial was 5% v 2.6%, darbe v placebo. -Indiana Resident

  2. The Treat Trial published recently in nejm also showed increased risk of stroke by 92 % . Should we ever give EPO for our predialysis patients ? I think not .

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