Outcomes of Early Versus Delayed Anemia Treatment in Nondialysis-Dependent CKD

• Published in: Kidney international reports Vol. 9; no. 7; pp. 2056 - 2066
• Main Authors: Kawai, Kouji, Ishii, Manabu, Kokado, Yoshimasa, Horikawa, Takashi, Hoshino, Junichi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2024; Elsevier
• Subjects: anemia in chronic kidney disease; cardiovascular outcomes; Clinical Research; erythropoiesis-stimulating agent; nationwide databases; nondialysis-dependent chronic kidney disease; renal outcomes; nationwide databases; nondialysis-dependent chronic kidney disease; cardiovascular outcomes; renal outcomes; anemia in chronic kidney disease; erythropoiesis-stimulating agent
• ISSN: 2468-0249; 2468-0249
• DOI: 10.1016/j.ekir.2024.04.030

The association of hemoglobin level at treatment initiation with renal and cardiovascular outcomes in patients with anemia in nondialysis-dependent (NDD) chronic kidney disease (CKD) is unclear. This retrospective cohort study utilized 2 Japanese databases (Medical Data Vision Co. Ltd., Tokyo, Japan [MDV]; and Real World Data Co. Ltd, Kyoto, Japan [RWD]). Patients initiated on long-acting erythropoiesis-stimulating agent (ESA) treatment were divided into early (hemoglobin levels ≥9.0 g/dl) and delayed (<9.0 g/dl) treatment groups. The primary outcome was a renal composite (renal replacement therapy, ≥50% estimated glomerular filtration rate [eGFR] reduction, eGFR <6.0 ml/min per 1.73 m2, and all-cause mortality), and secondary outcomes were a cardiovascular composite (hospitalization by ischemic heart disease, including myocardial infarction, hospitalization by stroke and heart failure, and cardiovascular death) and components of the composite outcomes. After propensity score matching, 1472 (MDV) and 1264 (RWD) patients were evaluated. Delayed treatment was not associated with a risk of the renal composite outcome (MDV: hazard ratio [HR]: 1.15, 95% confidence interval [CI]: 0.99–1.33; RWD: HR: 1.08, 95% CI: 0.92–1.28). However, delayed treatment was associated with higher risks of the cardiovascular composite outcome (MDV: HR: 1.47, 95% CI: 1.16–1.84; RWD: HR: 1.34, 95% CI: 1.09–1.64), heart failure (MDV: HR: 1.50, 95% CI: 1.13–2.00; RWD: HR: 1.53, 95% CI: 1.20–1.96) and all-cause mortality (MDV: HR: 1.83, 95% CI: 1.32–2.54; RWD: HR: 1.64, 95% CI: 1.21–2.22). Although the risk of renal events was not increased following delayed treatment of anemia in patients with NDD-CKD, the risks of cardiovascular events and all-cause mortality were increased, suggesting the importance of early intervention before hemoglobin falls below 9.0 g/dl. [Display omitted]