-Author name in bold denotes the presenting author
-Asterisk * with author name denotes a Non-ASH member
Clinically Relevant Abstract denotes an abstract that is clinically relevant.

PhD Trainee denotes that this is a recommended PHD Trainee Session.

Ticketed Session denotes that this is a ticketed session.

3397 Treatment Pathways of Non-Dialysis Dependent CKD Patients with Anemia: A Report from the Discover CKD Retrospective Cohort

Program: Oral and Poster Abstracts
Session: 901. Health Services Research—Non-Malignant Conditions: Poster III
Hematology Disease Topics & Pathways:
Anemias, Adult, Diseases, Study Population, Clinically relevant
Monday, December 7, 2020, 7:00 AM-3:30 PM

Eric Wittbrodt1*, Juan Jesus Carrero2*, Glen James3*, Steven Fishbane4*, Supriya R. Kumar1*, Roberto Pecoits-Filho5,6*, Juan Jose Garcia Sanchez3*, Carol A. Pollock7*, James A. Sloand1*, Katarina Hedman8* and David C. Wheeler9*

1AstraZeneca, Gaithersburg, MD
2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
3AstraZeneca, Cambridge, United Kingdom
4Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY
5Arbor Research Collaborative for Health, Ann Arbor, MI
6School of Medicine, Pontifical Catholic University of Parana, Curitiba, Brazil
7Royal North Shore Hospital, St. Leonards, NSW, Australia
8AstraZeneca, Gothenburg, Sweden
9University College London, London, United Kingdom

BACKGROUND: Anemia is a frequent complication of chronic kidney disease (CKD), yet most patients experiencing this problem remain untreated until the initiation of renal replacement therapy. We describe treatment pathways of key medications prescribed to non-dialysis dependent (NDD) CKD patients with anemia in DISCOVER CKD.

METHODS: Patients included in this analysis were extracted from the Limited Claims and EHR (LCED) data. The study cohort included patients aged >18 years with 2 estimate glomerular filtration rate (eGFR) measures <60 mL/min/1.73m2 >90 days apart between January 2008 and September 2018. The index date was the first Hb measure (<12 g/dL [females], <13 g/dL [males] per WHO criteria), or an anemia therapy (iron, ESA or blood transfusion) prescription after the 2nd eGFR measure. Exclusion criteria were: <1-year registration/medical history prior to index, active bleeding in the 30 days preceding and inclusive of index, an Hb value (only) within 30 days from transfusion or bleeding and no Hb measure within a year after CKD diagnosis. Oral iron was incompletely captured in LCED. Sankey Plots were used to visualize chronological treatment pathways (1st to 3rd line) post-index of key treatments commonly prescribed to CKD patients with anemia including: oral iron, IV Iron, ESA and blood transfusion.

RESULTS: Preliminarily, 1446 (2.6% of anemia base cohort) patients were prescribed anemia therapies during follow-up, with IV iron (32.5%), transfusions (30.5%), ESA (21.6%), oral iron (12.2%) and ESA+IV Iron (2.7%) used as 1st-line therapies, Figure 1. Median times to 1st-line therapy initiation after index were: 108 days for oral iron, 194 days for ESA, 197 days for IV iron, and 244 days for blood transfusion.

CONCLUSION: In routine clinical care, anemia in NDD CKD is under treated and rescue therapies are used for anemia more often than preventive therapies.

Disclosures: Wittbrodt: AstraZeneca: Current Employment, Current equity holder in private company. Carrero: AstraZeneca: Consultancy, Research Funding; Baxter: Consultancy, Research Funding; Vifor Pharma: Research Funding; Astellas: Consultancy, Research Funding. James: AstraZeneca: Current Employment, Current equity holder in private company. Fishbane: MegaPro Biomedical Co Ltd: Research Funding; AstraZeneca: Consultancy, Research Funding; Akebia Inc.: Research Funding; Cara Therapeutics: Research Funding; Corvidia Therapeutics: Research Funding; Ardelyx: Research Funding. Kumar: AstraZeneca: Current Employment, Current equity holder in private company. Pecoits-Filho: Fresenius Medical Care: Research Funding; Akebia: Consultancy; AstraZeneca: Consultancy. Garcia Sanchez: AstraZeneca: Current Employment, Current equity holder in private company. Pollock: Eli Lilly and Company: Consultancy; Otsuka Pharmaceuticals: Consultancy; Novartis: Consultancy; Janssen Cilag: Consultancy; AstraZeneca: Consultancy; FibroGen: Consultancy; Johnson and Johnson: Consultancy. Sloand: AstraZeneca: Current Employment, Current equity holder in private company. Hedman: AstraZeneca: Current Employment, Current equity holder in private company. Wheeler: AstraZeneca: Consultancy, Honoraria; Vifor Fresenius: Consultancy, Honoraria; Reata: Consultancy, Honoraria; Tricida: Consultancy, Honoraria; Merck Sharp and Dohme: Consultancy, Honoraria; Bayer: Consultancy, Honoraria; Boehringer Ingelheim: Consultancy, Honoraria; GlaxoSmithKline: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Napp: Consultancy, Honoraria; Mundipharma: Consultancy, Honoraria; Astellas: Consultancy, Honoraria.

*signifies non-member of ASH