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BMJ 2010; 340 doi: (Published 11 May 2010) Cite this as: BMJ 2010;340:c2486

More evidence against erythropoiesis stimulating agents

The latest meta-analysis of erythropoiesis stimulating agents confirms that people with chronic kidney disease risk thromboses and hypertension if their target haemoglobin is set too high. In an analysis of 27 trials, higher targets were associated with more strokes (relative risk 1.51, 95% CI 1.03 to 2.21), more thromboses of vascular access for dialysis (1.33, 1.16 to 1.53), and more hypertension (1.67, 1.31 to 2.12) than lower targets.

There were also more deaths and more cardiovascular events in patients treated aggressively, although the excess wasn’t statistically significant. The authors say their findings probably rule out any net benefit.

Precise targets varied and have crept up over time. For the past decade or so, trials have compared higher targets between 120 g/l and 150 g/l with lower targets between 90 g/l and 120 g/l. The authors had inadequate data on the doses of erythropoietins or darbepoetin needed to meet haemoglobin targets. So it is still unclear whether the problem lies with the drugs or the way we use them. Data on quality of life, arguably the most important outcome for patients, were too poor to be useful.

We now know that these agents are not the panacea they were originally thought to be, says an editorial ( But it is too early to abandon them and return to a time when chronic kidney disease meant intractable severe anaemia and multiple transfusions. There is a middle way, and further trials are needed to find it.

Performance enhancing drugs on trial

Growth hormone is a popular performance enhancing drug, banned by the World Anti-Doping Agency. But does it actually work?

It didn’t work terribly well for 96 volunteer athletes from Sidney, who were persuaded to take part in a randomised trial to help inform anti-doping policy. Daily injections of growth hormone helped improve the athletes’ sprint …

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