Contemporary outcomes of anemia in US patients with chronic kidney disease

Authors

Eric T. Wittbrodt, AstraZeneca, Biopharmaceuticals Medical, Gaithersburg, MD, USA.
Glen James, AstraZeneca, Biopharmaceuticals Medical, Cambridge, UK.
Supriya Kumar, AstraZeneca, Biopharmaceuticals Medical, Gaithersburg, MD, USA.
Heleen van Haalen, AstraZeneca, Biopharmaceuticals Medical, Gothenburg, Sweden.
Hungta Chen, AstraZeneca, Biopharmaceuticals Medical, Gaithersburg, MD, USA.
James A. Sloand, AstraZeneca, Biopharmaceuticals Medical, Gaithersburg, MD, USA.
Kamyar Kalantar-Zadeh, University of California, Irvine, CA, USA.

Document Type

Journal Article

Publication Date

2-1-2022

Journal

Clinical kidney journal

Volume

15

Issue

2

DOI

10.1093/ckj/sfab195

Keywords

CKD; anemia; epidemiology; hemoglobin; retrospective

Abstract

BACKGROUND: Long-term clinical outcome data from patients with non-dialysis-dependent (NDD) chronic kidney disease (CKD) are lacking. We characterized patients with NDD-CKD and anemia using real-world data from the USA. METHODS: This retrospective longitudinal observational study evaluated integrated Limited Claims and Electronic Health Record Data (IBM Health, Armonk, NY), including patients ≥18 years with two or more estimated glomerular filtration rate (eGFR) measures <60 mL/min/1.73 m ≥90 days apart. Anemia was defined as the first observed hemoglobin <10 g/dL within 6-month pre- and post-CKD index date. Data were analyzed from January 2012 to June 2018. Patients with documented iron-deficiency anemia at baseline were excluded. RESULTS: Comprising 22 720 patients (57.4% female, 63.9% CKD stage 3, median hemoglobin 12.5 g/dL), median (interquartile range) follow-up for patients with and without anemia were 2.9 (1.5-4.4) and 3.8 (2.2-4.8) years, respectively. The most prevalent comorbidities were dyslipidemia (57.6%), type 2 diabetes mellitus (38.8%) and uncontrolled hypertension (20.0%). Overall, 23.3% of patients had anemia, of whom 1.9% and <0.1% received erythropoiesis-stimulating agents (ESAs) or intravenous iron, respectively. Anemia prevalence increased with CKD stage from 18.2% (stage 3a) to 72.8% (stage 5). Patients with anemia had a higher incidence rate of hospitalizations for heart failure (1.6 versus 0.8 per 100 patient-years), CKD stage advancement (43.5 versus 27.5 per 100 patient-years), and a 40% eGFR decrease (18.1 versus 7.3 per 100 patient-years) versus those without anemia. CONCLUSIONS: Anemia, frequently observed in NDD-CKD and associated with adverse clinical outcomes, is rarely treated with ESAs and intravenous iron. These data suggest that opportunities exist for improved anemia management in patients with NDD-CKD.

APA Citation

Wittbrodt, E. T., James, G., Kumar, S., van Haalen, H., Chen, H., Sloand, J. A., & Kalantar-Zadeh, K. (2022). Contemporary outcomes of anemia in US patients with chronic kidney disease. Clinical kidney journal, 15 (2). http://dx.doi.org/10.1093/ckj/sfab195