What are the adverse effect of erythropoiesis-stimulating agents (ESAs) in the treatment of anemia of chronic disease and renal failure?

Updated: Apr 13, 2020
  • Author: Gates B Colbert, MD, FASN; Chief Editor: Emmanuel C Besa, MD  more...
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Long-term treatment with ESAs has been associated with increased systemic blood pressure and occurrence of seizures; hypertension has been documented to be a common side effect of intravenous use of ESAs. For this reason, blood pressure should always be closely monitored in patients administered with such agents. The postulated mechanism is believed to be an imbalance between endothelin and proendothelin that leads to hyperresponsiveness to the effects of norepinephrine (vasoconstriction) and hyporesponsiveness to the effects of nitric oxide (vasodilatation).

Reports of neutralizing "anti-epoetin antibodies" have been linked to the unusual occurrence of pure red cell aplasia (PRCA) in European cohorts, but this finding has been attributed to the difference in immunogenicity of the ESAs marketed between the US and Europe.

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