A Real World Longitudinal Analysis of Anemia Treatment Prescriptions in Non-Dialysis-Dependent Chronic Kidney Disease Patients, a CKDopps Study

Background: Previously lacking in the literature, this analysis aims to comprehensively describe longitudinal patterns of anemia management, including prescriptions of erythropoiesis-stimulating agent (ESA) and iron replacement, for non-dialysis dependent chronic kidney disease (NDD-CKD) stage 3 to 5 patients under nephrologist care.

Methods: We analyzed data from a prospective cohort of 2455 NDD-CKD patients from Brazil, Germany and the US, who were not using anemia medications (oral iron, intravenous [IV] iron, or ESA) at enrollment in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps). We reported the cumulative incidence (CI) of anemia treatment initiation, stratified by patient characteristics. For patients that started therapy, we report the frequency of medication type at the moment of initiation, as well as switches and discontinuation over 12 months.

Results: The CI of any anemia treatment initiation at 12 months was 54% for patients with Hb <10 g/dL. For oral iron therapy, the CI at 12 months was 26% (19%, 32%) for transferrin saturation (TSAT) <20%, and 22% (17%, 28%) for ferritin <100 ng/mL. For IV iron use, CI at 12 months was 6% (3%, 11%) for patients with TSAT <20% and 4% (2%, 7%) for patients with ferritin <100 ng/mL. For ESA use, the CI at 12 months was 38% (29%, 47%) for patients with Hb <10 g/dL, and 11% (8%, 14%) for Hb 10 to <12 g/dL. Medication types at initiation and longitudinal treatment patterns (switches and discontinuation) are shown in the figure.

Conclusion: In a period of 12 months, anemia medication is initiated in a limited number of NDD-CKD patients with clinical signs that would indicate to do so. This longitudinal analysis supports the concept that anemia is sub-optimally managed among patients with NDD CKD in the real-world setting.