More than 50% of CKD Patients with Anemia Receive No Treatment, Study Finds

An analysis of contemporary trends in the management of clinically meaningful anemia among patients with non-dialysis-dependent chronic kidney disease (CKD) suggests more than half received no prescriptions to address their anemia following diagnosis.

An analysis of more than 14,000 non-dialysis dependent CKD patients receiving care from 2015-2021, results of the study highlight 52.2% of patients did not receive any prescription for erythropoiesis-stimulating agents (ESA), intravenous (IV) iron, or red blood cell (RBC) transfusions following diagnosis.

“I think it's pointing out we need more attention to severe anemia in chronic kidney disease, because I think the balance has flipped too much towards being comfortable with severe anemia and being uncertain with what to do about it,” said study investigator Richard Lafayette, MD, founder and director of the Stanford Glomerular Disease Center, in an interview at the American Society of Nephrology Kidney Week 2023. “So, I think it's just a call to action to think about those patients and see if anemia can be treated a little bit better.”

Investigators launched their research endeavor with the intent of assessing the treatment patterns of relative to the KDIGO guidelines as well as to evaluate characteristics of non-dialysis dependent CKD patients. With this in mind, investigators designed their study as an analysis of patients with at least 1 year of available data from within the Optum Electronic Health Records database.

Of note, at the time of writing, KDIGO is exploring updates to their anemia guidance, which was last updated in 2012.

An initial search, spanning January 1, 2015, through December 31, 2021, returned more than 73 million patients with at least 1 year of data available. Among this group, investigators identified a cohort of 14,992 non-dialysis-dependent CKD patients with clinically meaningful anemia for inclusion in the current study.

The study cohort had a mean age of 73.8 (Standard deviation [SD], 10.3) years, 46.3% were men, and a mean baseline eGFR of 44.3 (SD, 12.8) mL/min/1.73m2. Investigators pointed out 74.1% had hypertension, 24.2% had peripheral vascular disease, and 27.2% had coronary artery disease. Investigators also noted the cohort had mean hemoglobin of 9.2 (SD, 0.6) g/dL, with 96.3% of the cohort having baseline hemoglobin between 8.0 to 9.9 g/dL.

Upon analysis, results indicated 52.2% of patients received no prescriptions for IV iron, RBC transfusion, or ESAs after anemia diagnosis. For those who received a prescription, IV iron, RBC transfusion, and ESAs were prescribed as a first anemia treatment among 18.4%, 24.6%, and 4.8% of the cohort, respectively. Further analysis indicated.

For more perspective on the current landscape of anemia management in patients with CKD, check out our interview with Lafayette at Kidney Week 2023.

References:

1. Ma J, Salem N, Moore C, et al. Contemporary Treatment Patterns of Clinically Meaningful Anemia Among Non-Dialysis-Dependent CKD Patients in the United States. Paper Presented at: American Society of Nephrology Kidney Week 2023. November 1-5, 2023.
2. KDIGO. Guideline resources. KDIGO. Accessed November 4, 2023. https://kdigo.org/guidelines/anemia-in-ckd/.