Prevalence, incidence, and treatment of anaemia in patients with non-dialysis-dependent chronic kidney disease: findings from a retrospective real-world study in Italy

• Published in: Journal of nephrology Vol. 36; no. 2; pp. 347 - 357
• Main Authors: Minutolo, Roberto, Grandaliano, Giuseppe, Di Rienzo, Paolo, Snijder, Robert, Degli Esposti, Luca, Perrone, Valentina, Todorova, Lora
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.03.2023
• Subjects: Adult; Anemia - diagnosis; Anemia - epidemiology; Anemia - therapy; Hematinics - therapeutic use; Hemoglobins; Humans; Incidence; Iron - therapeutic use; Italy - epidemiology; Medicine; Medicine & Public Health; Nephrology; Original; Original Article; Prevalence; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - therapy; Retrospective Studies; Urology; Italy; Non-dialysis-dependent CKD; ESA; Anaemia; Real world; Epidemiology; Retrospective
• DOI: 10.1007/s40620-022-01475-x
• ISSN: 1724-6059; 1121-8428

Background Limited data are available on the epidemiology and clinical management of anaemia in patients with non-dialysis-dependent chronic kidney disease (NDD-CKD). Methods This retrospective observational study was based on records from databases of five Local Health Units across Italy. Adults with reported NDD-CKD stage 3a–5 between 1 January 2014 and 31 December 2016 were identified. Annual prevalence and incidence of anaemia (age- and sex-standardised) and clinical management (erythropoiesis-stimulating agents [ESAs], intravenous [IV] iron, and blood transfusions) were evaluated. Eligibility for ESAs was defined by ≥ 2 records of Hb < 10 g/dL, or < 11 g/dL over 6 months. Results Overall, 101,143 individuals with NDD-CKD (3a–5) recorded between 2014 and 2016 were identified, of whom 40,020 (39.6%) were anaemic. Prevalence of anaemia was 33.8% in 2016 and incidence of anaemia was stable (11.4–12.4%) from 2014 to 2016. Prevalence and incidence of anaemia increased with CKD stage. Among eligible patients, 12.8% with Hb < 11 g/dL and 15.5% with Hb < 10 g/dL received ESAs, and the proportion treated increased with CKD stage. Among ESA-treated patients with at least 2 years of follow up, 18.4% and 19.3% received IV iron in the Hb < 11 and < 10 g/dL groups, respectively, and 16.5% and 19.4% received blood transfusions. Corresponding proportions for the overall anaemic cohort were 9.0% and 11.3%, respectively. Conclusions Anaemia is a significant issue in patients with NDD-CKD. Low rates of ESA treatment indicate a potential treatment gap and suggest that anaemia may not be adequately controlled in many patients. Graphical abstract