The mortality risk associated with higher hemoglobin: is the therapy to blame?

Recent trials have demonstrated a trend for increased mortality when patients with end-stage renal disease (ESRD) or chronic kidney disease (CKD) are treated with erythropoietin-stimulating agents (ESAs) to hemoglobin levels higher than recommended (>13 g/dl). Recent studies suggest that higher doses of ESAs, in themselves, may be at least partly responsible for this mortality risk. This is important, as more than 90% of patients with ESRD and approximately 20% of patients with CKD receive ESAs. Two new studies address this.