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A Point-of-Care Method with Integrated Decision Support Tool to Estimate Anemia at Population Level
Published on: January 19, 2024
Anemia prevalence and treatment patterns in chronic kidney disease: a nationwide observational study using a Japanese
Tetsuhiro Tanaka1, Shinji Asada2, Kohei Suzuki2
1Department of Nephrology, Tohoku University Graduate School of Medicine, Miyagi, Japan.
Insights
Oral hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs) are increasingly used for anemia in chronic kidney disease (CKD) patients in Japan. This shift is changing anemia treatment patterns in primary care settings.
Area of Science:
- Nephrology
- Hematology
- Pharmacology
Background:
- Anemia in chronic kidney disease (CKD) is linked to adverse outcomes like disease progression and mortality.
- Current treatments include iron and injectable erythropoiesis-stimulating agents (ESAs).
- Oral hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs) offer a new, accessible treatment option.
Purpose of the Study:
- To analyze the prevalence and treatment of anemia in non-dialysis CKD patients in Japanese primary care.
- To examine trends in anemia treatment types, specifically the uptake of HIF-PHIs versus ESAs.
- To assess anemia prevalence and treatment patterns across different CKD stages and patient demographics.
Main Methods:
- A real-world descriptive study utilizing the Japan Medical Data Survey database.
- Analysis of data from January 2018 to December 2023.
- Subgroup analysis by year, CKD stage, patient age, treatment setting, sex, and region.
Main Results:
- Anemia treatment rates rose from 16.4% to 22.7% between 2018 and 2023.
- HIF-PHI use increased significantly from 2020, surpassing ESAs in 2022-2023.
- Patients with more severe CKD and older individuals exhibited higher anemia prevalence and increased use of both HIF-PHIs and ESAs.
Conclusions:
- The adoption of oral HIF-PHIs in Japanese primary care is growing.
- This increasing use of HIF-PHIs is altering the landscape of anemia management for CKD patients.
Background:
Anemia in chronic kidney disease (CKD) is associated with poor outcomes, including CKD progression, mortality, and cardiovascular events. Standard treatments include iron supplements and injectable erythropoiesis-stimulating agents (ESAs). Oral hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs) have recently emerged as a new treatment option, providing easier accessibility for general practitioners.
Methods:
This real-world descriptive study used the Japan Medical Data Survey database to analyze the prevalence of anemia, anemia treatment, and treatment type in non-dialysis patients with CKD and treated in primary care clinics. Data from 1 January 2018 to 31 December 2023 were assessed and analyzed by subgroups (year, CKD stage, patient age, treatment setting, sex, and region).
Results:
This study included 397,419 patients. Anemia treatment rates increased from 16.4% (2018) to 22.7% (2023), accompanied by an increased proportion of patients with hemoglobin levels ≥ 11 g/dL (78.8%-87.9%). From 2020, use of HIF-PHIs increased and use of ESAs decreased, with HIF-PHIs overtaking ESAs in 2022-2023. During 2022-2023 (N = 340,398), patients with more severe CKD stages had lower hemoglobin levels and an increased prevalence of anemia (11.6% [CKD G3a]-73.6% [CKD G5]). Older patients tended to have lower hemoglobin values, increased anemia prevalence, more severe CKD, and increased use of HIF-PHIs and ESAs.
Conclusion:
Use of HIF-PHIs in primary care settings in Japan is increasing, resulting in changes to anemia treatment received by patients with CKD.
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