Is there a deleterious effect of erythropoietin in end-stage renal disease?

The use of erythropoiesis-stimulating agents (ESAs) in patients with chronic kidney disease has declined as randomized controlled trials have demonstrated increased risk of cardiovascular complications and mortality without a marked benefit in quality of life. Several studies have suggested that exposure to high dosages of ESA, rather than raising of the hemoglobin concentration, explains this increased risk. Cotter and colleagues report that exposure to high dosages of ESA in patients with diabetes is associated with increased risk.