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Published on: January 19, 2024
Real-Life Anemia Management Among Patients with Non-Dialysis-Dependent Chronic Kidney Disease in Three European
Danilo Fliser1, Maria Mata Lorenzo2, Katherine Houghton3
1Saarland University Medical Center, Homburg, Germany.
Insights
Anemia management in non-dialysis-dependent chronic kidney disease (NDD-CKD) patients using erythropoiesis-stimulating agents (ESAs) was assessed. While ESA initiation followed guidelines, monitoring of hemoglobin and iron levels was suboptimal.
Area of Science:
- Nephrology
- Hematology
- Pharmacotherapy
Background:
- Anemia is a common complication in chronic kidney disease (CKD).
- Current anemia treatments may not align with Kidney Disease: Improving Global Outcomes (KDIGO) guidelines.
- Management of anemia in non-dialysis-dependent CKD (NDD-CKD) patients requires further investigation.
Purpose of the Study:
- To document the management of NDD-CKD patients receiving erythropoiesis-stimulating agent (ESA) therapy in Europe.
- To evaluate adherence to KDIGO guidelines in ESA treatment for NDD-CKD.
- To analyze treatment response, iron therapy, and clinical outcomes in ESA-treated NDD-CKD patients.
Main Methods:
- Retrospective, observational study using medical records from Germany, Spain, and the UK.
- Included adult patients with NDD-CKD stages 3b-5 initiating ESA therapy for anemia (hemoglobin <13.0 g/dL males, <12.0 g/dL females) in 2015.
- Extracted data on ESA treatment, iron therapy, blood transfusions, and CKD progression up to 24 months post-initiation.
Main Results:
- 848 records were analyzed; 40% received no iron therapy pre-ESA initiation.
- Mean hemoglobin at ESA initiation was 9.8 ± 1.0 g/dL; darbepoetin alfa was most common.
- Hb levels reached target (10-12 g/dL) within 3-6 months, but monitoring of Hb, transferrin saturation, and ferritin was infrequent.
- Rates of blood transfusion, dialysis, and end-stage renal disease were 16.4%, 19.3%, and 24.6%, respectively.
Conclusions:
- ESA initiation in NDD-CKD patients generally followed KDIGO guidelines.
- Subsequent monitoring of hemoglobin and iron deficiency during ESA therapy was suboptimal.
- Further research is needed to optimize long-term anemia management in NDD-CKD.
Background:
Anemia is prevalent among patients with chronic kidney disease (CKD), yet current evidence indicates that treatment may not adhere to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. We aimed to document the management of patients with non-dialysis-dependent (NDD)-CKD receiving erythropoiesis-stimulating agent (ESA) therapy in Europe.
Methods:
This retrospective, observational study extracted information from medical records in Germany, Spain, and the UK. Eligible patients were adults with NDD-CKD stages 3b-5 who initiated ESA therapy for anemia between January and December 2015. Anemia was defined as hemoglobin (Hb) <13.0 g/dL (males) or <12.0 g/dL (females). Data regarding ESA treatment, treatment response, concomitant iron therapy and blood transfusions were extracted up to 24 months post-ESA initiation, and data on CKD progression until abstraction date.
Results:
Eight hundred and forty-eight medical records were abstracted. Approximately 40% received no iron therapy prior to ESA initiation. At ESA initiation, mean ± standard deviation Hb level was 9.8 ± 1.0 g/dL. Most patients received darbepoetin alfa, and switching between ESAs was rare (8.5% of patients). Concomitant intravenous and oral iron therapy was prescribed for 36% and 42% of patients, respectively, during initial ESA therapy. Mean Hb levels reached the target level (10-12 g/dL) within 3-6 months of ESA initiation. Hb, transferrin saturation, and ferritin levels were infrequently monitored from 3 months post-ESA initiation. Rates of blood transfusion, dialysis, and diagnosis of end-stage renal disease were 16.4%, 19.3%, and 24.6%, respectively. Rates of kidney transplant and death were 4.8% and 8.8%, respectively.
Conclusion:
Among ESA-treated patients, ESA initiation was in accordance with KDIGO guidelines, but subsequent monitoring of Hb and iron deficiency were suboptimal.
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