Scientific Reports (Jan 2021)

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

  • Marcelo Barreto Lopes,
  • Charlotte Tu,
  • Jarcy Zee,
  • Murilo Guedes,
  • Ronald L. Pisoni,
  • Bruce M. Robinson,
  • Bryce Foote,
  • Katarina Hedman,
  • Glen James,
  • Antonio Alberto Lopes,
  • Ziad Massy,
  • Helmut Reichel,
  • James Sloand,
  • Sandra Waechter,
  • Michelle M. Y. Wong,
  • Roberto Pecoits-Filho

DOI
https://doi.org/10.1038/s41598-020-79254-6
Journal volume & issue
Vol. 11, no. 1
pp. 1 – 12

Abstract

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Abstract 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.