Epidemiology and outcomes in patients with anemia of CKD not on dialysis from a large US healthcare system database: a retrospective observational study

• Published in: BMC nephrology Vol. 23; no. 1; p. 166
• Main Authors: Lamerato, Lois, James, Glen, van Haalen, Heleen, Hedman, Katarina, Sloand, James A, Tang, Amy, Wittbrodt, Eric T, Yee, Jerry
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 30.04.2022; BioMed Central; BMC
• Subjects: Adult; Anemia; Anemia - drug therapy; Anemia - therapy; Bleeding; Blood transfusion; Cardiovascular Diseases - complications; Care and treatment; Chronic kidney disease; Chronic kidney failure; Clinical outcomes; Complications and side effects; Delivery of Health Care; Diagnosis; Dialysis; Epidemiology; Erythrocytes; Erythropoiesis; Female; Glomerular filtration rate; Health care; Hemodialysis; Hemoglobin; Hospitalization; Humans; Iron; Kidney diseases; Kidney Failure, Chronic - therapy; Laboratories; Male; Mortality; Nephrology; Observational studies; Patients; Real-world evidence; Renal Dialysis - adverse effects; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - therapy; Retrospective Studies; Risk factors; Survival analysis; United States; United States > US; Michigan; Anemia; Chronic kidney disease; Real-world evidence
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-022-02778-8

Optimal management of anemia of chronic kidney disease (CKD) remains controversial. This retrospective study aimed to describe the epidemiology and selected clinical outcomes of anemia in patients with CKD in the US. Data were extracted from Henry Ford Health System databases. Adults with stages 3a-5 CKD not on dialysis (estimated glomerular filtration rate < 60 mL/min/1.73m ) between January 1, 2013 and December 31, 2017 were identified. Patients on renal replacement therapy or with active cancer or bleeding were excluded. Patients were followed for ≥12 months until December 31, 2018. Outcomes included incidence rates per 100 person-years (PY) of anemia (hemoglobin < 10 g/dL), renal and major adverse cardiovascular events, and of bleeding and hospitalization outcomes. Adjusted Cox proportional hazards models identified factors associated with outcomes after 1 and 5 years. Among the study cohort (N = 50,701), prevalence of anemia at baseline was 23.0%. Treatments used by these patients included erythropoiesis-stimulating agents (4.1%), iron replacement (24.2%), and red blood cell transfusions (11.0%). Anemia incidence rates per 100 PY in patients without baseline anemia were 7.4 and 9.7 after 1 and 5 years, respectively. Baseline anemia was associated with increased risk of renal and major cardiovascular events, hospitalizations (all-cause and for bleeding), and transfusion requirements. Increasing CKD stage was associated with increased risk of incident anemia, renal and major adverse cardiovascular events, and hospitalizations. Anemia was a prevalent condition associated with adverse renal, cardiovascular, and bleeding/hospitalization outcomes in US patients with CKD. Anemia treatment was infrequent.