A real-world longitudinal study of anemia management in non-dialysis-dependent chronic kidney disease patients: a multinational analysis of CKDopps

• Published in: Scientific reports Vol. 11; no. 1; pp. 1784 - 12
• Main Authors: Lopes, Marcelo Barreto, Tu, Charlotte, Zee, Jarcy, Guedes, Murilo, Pisoni, Ronald L., Robinson, Bruce M., Foote, Bryce, Hedman, Katarina, James, Glen, Lopes, Antonio Alberto, Massy, Ziad, Reichel, Helmut, Sloand, James, Waechter, Sandra, Wong, Michelle M. Y., Pecoits-Filho, Roberto
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 19.01.2021; Nature Publishing Group; Nature Portfolio
• Subjects: 692/699/1585; 692/699/1585/104; Anemia; Congestive heart failure; Dialysis; Erythropoiesis; Heart failure; Hemoglobin; Humanities and Social Sciences; Intravenous administration; Iron; Iron deficiency; Kidney diseases; Kidneys; Longitudinal studies; multidisciplinary; Nutrient deficiency; Science; Science (multidisciplinary)
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-020-79254-6

Previously lacking in the literature, we describe longitudinal patterns of anemia prescriptions for non-dialysis-dependent chronic kidney disease (NDD-CKD) patients under nephrologist care. We analyzed data from 2818 Stage 3-5 NDD-CKD patients from Brazil, Germany, and the US, naïve to anemia medications (oral iron, intravenous [IV] iron, or erythropoiesis stimulating agent [ESA]) at enrollment in the CKDopps. We report the cumulative incidence function (CIF) of medication initiation stratified by baseline characteristics. Even in patients with hemoglobin (Hb) < 10 g/dL, the CIF at 12 months for any anemia medication was 40%, and 28% for ESAs. Patients with TSAT < 20% had a CIF of 26% and 6% for oral and IV iron, respectively. Heart failure was associated with earlier initiation of anemia medications. IV iron was prescribed to < 10% of patients with iron deficiency. Only 40% of patients with Hb < 10 g/dL received any anemia medication within a year. Discontinuation of anemia treatment was very common. Anemia treatment is initiated in a limited number of NDD-CKD patients, even in those with guideline-based indications to treat. Hemoglobin trajectory and a history of heart failure appear to guide treatment start. These results support the concept that anemia is sub-optimally managed among NDD-CKD patients in the real-world setting.