Side Effects of Erythropoietin in CKD Patients with Anemia
Hypertension is the most common side effect of erythropoietin (EPO) therapy in CKD patients, occurring in approximately 23% of treated patients. 1
Major Side Effects of Erythropoietin
Hypertension
- Occurs in approximately 23% of CKD patients treated with EPO 1
- Mechanism involves:
- Management:
- Blood pressure monitoring, particularly during initiation of therapy
- Initiation or increase of antihypertensive medications
- Intensified ultrafiltration if extracellular volume expansion is present
- Reduction in EPO dose if rapid hemoglobin rise occurs 1
Seizures
- Can occur during EPO therapy, especially with hypertensive encephalopathy 1
- Not associated with EPO dose or rate of hemoglobin increase
- More common with higher doses used in earlier years of EPO therapy 1
- Often associated with rapid increases in blood pressure 1
- Management:
- EPO should be discontinued if hypertensive encephalopathy with seizures occurs until clinical stability is achieved 1
Other Potential Side Effects
- Increased clotting tendency/thrombosis (though evidence suggests no increased need for surveillance) 1
- Pure red cell aplasia (PRCA) - rare but serious complication due to neutralizing antibodies 1
- Hyperkalemia (though recent data indicate incidence is not significantly higher) 1
Analyzing the Multiple Choice Options
Looking at the options provided in the question:
- A. Intracranial hyperplasia - Not a documented side effect of EPO
- B. Hypotension - Opposite of the most common side effect (hypertension)
- C. Hypercalcemia - Not a documented side effect of EPO
- D. Osteoporosis - Not a documented side effect of EPO
- E. Seizures - Documented side effect, especially in association with hypertensive encephalopathy 1
Based on the evidence from the National Kidney Foundation guidelines, seizures are a recognized side effect of erythropoietin therapy in CKD patients, particularly when associated with hypertensive encephalopathy. While hypertension is the most common side effect, seizures represent a serious adverse effect that can occur during treatment.
Therefore, among the given options, seizures (option E) is the correct answer as it is a documented side effect of erythropoietin therapy in CKD patients with anemia.