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

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.