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de Jong MF, Nemeth E, Rawee P, Bramham K, Eisenga MF. Anemia in Pregnancy With CKD. Kidney Int Rep 2024; 9:1183-1197. [PMID: 38707831 PMCID: PMC11069017 DOI: 10.1016/j.ekir.2024.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 12/05/2023] [Accepted: 01/08/2024] [Indexed: 05/07/2024] Open
Abstract
Chronic kidney disease (CKD), anemia, and iron deficiency are global health issues affecting individuals in both high-income and low-income countries. In pregnancy, both CKD and iron deficiency anemia increase the risk of adverse maternal and neonatal outcomes, including increased maternal morbidity and mortality, stillbirth, perinatal death, preterm birth, and low birthweight. However, it is unknown to which extent iron deficiency anemia contributes to adverse outcomes in CKD pregnancy. Furthermore, little is known regarding the prevalence, pathophysiology, and treatment of iron deficiency and anemia in pregnant women with CKD. Therefore, there are many unanswered questions regarding optimal management with oral or i.v. iron and recombinant human erythropoietin (rhEPO) in these women. In this review, we present a short overview of the (patho)physiology of anemia in healthy pregnancy and in people living with CKD. We present an evaluation of the literature on iron deficiency, anemia, and nutritional deficits in pregnant women with CKD; and we evaluate current knowledge gaps. Finally, we propose research priorities regarding anemia in pregnant women with CKD.
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Affiliation(s)
- Margriet F.C. de Jong
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, The Netherlands
| | - Elizabeta Nemeth
- Department of Medicine, University of California, Los Angeles, California, USA
| | - Pien Rawee
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, The Netherlands
| | - Kate Bramham
- Department of Women and Children’s Health, King’s College London, London, UK
| | - Michele F. Eisenga
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, The Netherlands
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Clancy CC, Browne LD, Gilligan R, Blake O, Stack AG. Prevalence of anaemia, iron, and vitamin deficiencies in the health system in the Republic of Ireland: a retrospective cohort study. BJGP Open 2024:BJGPO.2023.0126. [PMID: 38092441 DOI: 10.3399/bjgpo.2023.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/13/2023] [Accepted: 10/31/2023] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Anaemia is a common but treatable condition that predicts adverse clinical outcomes. However, standards of anaemia management vary considerably. AIM To estimate the prevalence of anaemia and extent of screening for common underlying causes in the healthcare system in the Republic of Ireland. DESIGN & SETTING We conducted a retrospective cohort study of 112 181 adult patients, aged ≥18 years, who had a full blood count performed in 2013, using data from the National Kidney Disease Surveillance System. METHOD The prevalence of anaemia was determined across demographic and clinical subgroups, according to World Health Organization (WHO) definitions. The proportion screened for iron, vitamin B12, and folate deficiency was determined within a 3-month follow-up period and the corresponding prevalence for each deficiency determined. RESULTS The overall prevalence of anaemia was 12.0% (95% confidence interval [CI] = 11.8% to 12.2%) and was higher in women than men (13.2% versus 10.5%, P<0.001). Anaemia increased with advancing age (33.4% for those aged >75 years) and worsening kidney function (8.2%, 10.9%, 33.2%, and 63.8% for each estimated glomerular filtration rate [eGFR] categories >90, 60-89, 30-59 and <30 ml/min/1.73 m², respectively, P<0.001). After 3-months' follow-up, the proportion screened for iron deficiency was 11.2% based on transferrin saturation and 33.7% using serum ferritin. Screening for folate and B12 deficiency was 17.6% and 19.8%, respectively. Among screened patients, the prevalence of iron deficiency, B12, and folate deficiency was 37.0%, 6.3%, and 5.8%, respectively. CONCLUSION The burden of anaemia in the healthcare system is substantial especially for older patients and those with advanced kidney disease. Low screening rates for iron, B12, and folate deficiency are common and warrant quality improvement initiatives.
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Affiliation(s)
| | - Leonard D Browne
- School of Medicine, University of Limerick, Limerick, Ireland
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland
| | - Robert Gilligan
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Ophelia Blake
- Department of Biochemistry, University Hospital Limerick, Limerick, Ireland
| | - Austin G Stack
- School of Medicine, University of Limerick, Limerick, Ireland
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland
- Department of Nephrology, University Hospital Limerick, Limerick, Ireland
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Roldão M, Escoli R, Gonçalves H, Lobos AV. Efficiency of ferric carboxymaltose in non-dialysis CKD patients and its impact on kidney function: a prospective observational study. Int Urol Nephrol 2023; 55:953-959. [PMID: 36173535 DOI: 10.1007/s11255-022-03360-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/21/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Iron deficiency anemia occurs in most patients with non-dialysis chronic kidney disease (ND-CKD). Previous studies have suggested that intravenous (IV) iron therapy is more effective than oral iron in these patients. Clinical evidence relating the effects of IV iron on renal function is, however, limited. METHODS Prospective observational study of adult patients with ND-CKD, anemia, iron deficiency, and estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, treated with a single dose of 500 mg or 1000 mg of ferric carboxymaltose (FCM) and followed-up for 24 weeks. Primary outcome was FCM efficacy, assessed by comparing Hb, TSAT and ferritin at 24 weeks with those at baseline. Secondary outcome was FCM impact on renal function, evaluated by comparing eGFR over the same period. RESULTS One hundred and forty patients were recruited: seventy-eight (55.7%) were treated with 1000 mg and 62 (44.3%) with 500 mg of FCM. 24 weeks after FCM administration, Hb increased 1.54 ± 1.99 g/dL (95% CI 1.09-1.99, p = 001) in the group treated with 1000 mg and 0.86 ± 1.4 g/dL (95% CI 0.53-1.22, p = 0.001) in those treated with 500 mg. TSAT increased in both groups but more in those treated with 1000 mg, and ferritin only increased in the latter. Estimated GFR showed a significant increase of 1.55 ± 6.86 mL/min/m2 (95% CI 0.05-3.09, p = 0.049), from a baseline of 27.73 ± 17.23 to 28.88 ± 18.02 mL/min/m2 in the group treated with 1000 mg. CONCLUSIONS Our findings suggested that IV FCM therapy was effective in improving serum iron levels and anemia in ND-CKD stage 3 to 5 patients. Higher doses seem to be necessary to replace depleted iron stores. In our cohort, IV FCM therapy was associated with an improvement in renal function, particularly in those treated with higher doses of FCM.
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Affiliation(s)
- Marisa Roldão
- Department of Nephrology, Centro Hospitalar do Médio Tejo, Av. Xanana Gusmão 45, 2350-754, Torres Novas, Portugal.
| | - Rachele Escoli
- Department of Nephrology, Centro Hospitalar do Médio Tejo, Av. Xanana Gusmão 45, 2350-754, Torres Novas, Portugal
| | - Hernâni Gonçalves
- Department of Nephrology, Centro Hospitalar do Médio Tejo, Av. Xanana Gusmão 45, 2350-754, Torres Novas, Portugal
| | - Ana Vila Lobos
- Department of Nephrology, Centro Hospitalar do Médio Tejo, Av. Xanana Gusmão 45, 2350-754, Torres Novas, Portugal
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Fliser D, Mata Lorenzo M, Houghton K, Ainsworth C, Blogg M, González de Antona Sánchez E, Portoles J. Real-Life Anemia Management Among Patients with Non-Dialysis-Dependent Chronic Kidney Disease in Three European Countries. Int J Nephrol Renovasc Dis 2023; 16:115-129. [PMID: 37077414 PMCID: PMC10108867 DOI: 10.2147/ijnrd.s401598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/18/2023] [Indexed: 04/21/2023] Open
Abstract
Background Anemia is prevalent among patients with chronic kidney disease (CKD), yet current evidence indicates that treatment may not adhere to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. We aimed to document the management of patients with non-dialysis-dependent (NDD)-CKD receiving erythropoiesis-stimulating agent (ESA) therapy in Europe. Methods This retrospective, observational study extracted information from medical records in Germany, Spain, and the UK. Eligible patients were adults with NDD-CKD stages 3b-5 who initiated ESA therapy for anemia between January and December 2015. Anemia was defined as hemoglobin (Hb) <13.0 g/dL (males) or <12.0 g/dL (females). Data regarding ESA treatment, treatment response, concomitant iron therapy and blood transfusions were extracted up to 24 months post-ESA initiation, and data on CKD progression until abstraction date. Results Eight hundred and forty-eight medical records were abstracted. Approximately 40% received no iron therapy prior to ESA initiation. At ESA initiation, mean ± standard deviation Hb level was 9.8 ± 1.0 g/dL. Most patients received darbepoetin alfa, and switching between ESAs was rare (8.5% of patients). Concomitant intravenous and oral iron therapy was prescribed for 36% and 42% of patients, respectively, during initial ESA therapy. Mean Hb levels reached the target level (10-12 g/dL) within 3-6 months of ESA initiation. Hb, transferrin saturation, and ferritin levels were infrequently monitored from 3 months post-ESA initiation. Rates of blood transfusion, dialysis, and diagnosis of end-stage renal disease were 16.4%, 19.3%, and 24.6%, respectively. Rates of kidney transplant and death were 4.8% and 8.8%, respectively. Conclusion Among ESA-treated patients, ESA initiation was in accordance with KDIGO guidelines, but subsequent monitoring of Hb and iron deficiency were suboptimal.
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Affiliation(s)
- Danilo Fliser
- Saarland University Medical Center, Homburg, Germany
- Correspondence: Danilo Fliser, Saarland University Medical Center, Homburg, Germany, Tel +49 – 6841 – 16 15040, Fax +49 – 6841 – 16 15454, Email
| | | | | | | | | | | | - Jose Portoles
- Hospital Universitario Puerta de Hierro, Madrid, Spain
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Laras H, Haddoum F, Baghdali FY, Gagi N, Koceir EHA, Bitam A. [Prevalence of malnutrition and absolute and functional iron deficiency anemia in nondialysis-dependent chronic kidney disease and hemodialysis Algerian patients]. Nephrol Ther 2022; 18:237-246. [PMID: 35644772 DOI: 10.1016/j.nephro.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 01/23/2022] [Accepted: 03/10/2022] [Indexed: 11/18/2022]
Abstract
In chronic kidney disease, anemia and malnutrition coupled with inflammation as malnutrition-inflammation complex syndrom are common and considered as morbidity-mortality factors. The link between these two factors has been described at length in the literature highlighting an association of malnutrition with iron deficiency considered itself as one of the causes of anemia in chronic kidney disease (non-dialysis and hemodialysis). Our study aims to know the prevalence of these two factors in a population of chronic kidney disease (non-dialysis and hemodialysis) of Algiers and to highlight the possible associations between them. PATIENTS AND METHODS This is a multicentre, cross-sectional and descriptive study carried out over a period of 6months (August 2018 to January 2019). Anemia and malnutrition were assessed by various biological and clinical tools such as the malnutrition inflammation score and the International Society of Renal Nutrition and Metabolism criteria. Statistical tests were performed on the R studio software, considering P<0.05 as a statistically significant value. RESULTS Two hundred and nine patients on chronic kidney disease were included (90 non dialysis and 119 hemodialysis). The median age was 70 (IQR=16) for non dialysis and 56 (IQR=16.5) for hemodialysis. The prevalence of anemia was 66.66% (n=60) in non dialysis and 70.58% (n=84) in hemodialysis. Absolute iron deficiency anemia was higher in non dialysis (48.33%; n=29) while functional iron deficiency anemia was higher in hemodialysis (34.52%; n=29). The prevalence of malnutrition by malnutrition inflammation score was relatively low. Only functional iron deficiency anemia was associated with malnutrition. CONCLUSION The prevalence of anemia was higher in Algerian chronic kidney disease (non-dialysis and hemodialysis) unlike malnutrition which remains associated with functional iron deficiency anemia.
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Affiliation(s)
- Hayat Laras
- Département de biologie et physiologie des organismes (BPO), laboratoire de bioénergétique et métabolisme intermédiaire, Faculté des Sciences Biologiques, université des sciences et de la technologie Houari Boumediene (USTHB), Alger, Algérie; Département de médecine, faculté des sciences de la santé, laboratoire risque cardiovasculaire en néphrologie et transplantation, université d'Alger 1, Alger, Algérie.
| | - Farid Haddoum
- Département de médecine, faculté des sciences de la santé, laboratoire risque cardiovasculaire en néphrologie et transplantation, université d'Alger 1, Alger, Algérie; Service de néphrologie, hémodialyse et transplantation, Centre Hospitalier Universitaire Mustapha Pacha, Alger, Algérie
| | - Feriel-Yasmine Baghdali
- Département de médecine, faculté des sciences de la santé, laboratoire risque cardiovasculaire en néphrologie et transplantation, université d'Alger 1, Alger, Algérie; Service de néphrologie, hémodialyse et transplantation, Centre Hospitalier Universitaire Mustapha Pacha, Alger, Algérie
| | - Nadia Gagi
- Département de médecine, faculté des sciences de la santé, université d'Alger 1 et laboratoire central de biochimie, Centre Hospitalier Universitaire Mustapha Pacha, Alger, Algérie
| | - El Hadj Ahmed Koceir
- Département de biologie et physiologie des organismes (BPO), laboratoire de bioénergétique et métabolisme intermédiaire, Faculté des Sciences Biologiques, université des sciences et de la technologie Houari Boumediene (USTHB), Alger, Algérie
| | - Arezki Bitam
- Département de biologie et physiologie des organismes (BPO), laboratoire de bioénergétique et métabolisme intermédiaire, Faculté des Sciences Biologiques, université des sciences et de la technologie Houari Boumediene (USTHB), Alger, Algérie; Département de technologie alimentaire, École nationale supérieure agronomique (ENSA), Laboratoire de recherche en technologie alimentaire et nutrition humaine, El-Harrach, Alger, Algérie
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Lamerato L, James G, van Haalen H, Hedman K, Sloand JA, Tang A, Wittbrodt ET, Yee J. Epidemiology and outcomes in patients with anemia of CKD not on dialysis from a large US healthcare system database: a retrospective observational study. BMC Nephrol 2022; 23:166. [PMID: 35490226 PMCID: PMC9055693 DOI: 10.1186/s12882-022-02778-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/22/2022] [Indexed: 11/12/2022] Open
Abstract
Background 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. Methods 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/1.73m2) 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. Results 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. Conclusions Anemia was a prevalent condition associated with adverse renal, cardiovascular, and bleeding/hospitalization outcomes in US patients with CKD. Anemia treatment was infrequent. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02778-8.
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Affiliation(s)
- Lois Lamerato
- Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place - 3E, Detroit, MI, 48202, USA.
| | - Glen James
- Cardiovascular, Renal, Metabolism Epidemiology, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK.,Integrated Evidence Generation & Business Innovation, Bayer PLC, Reading, UK
| | - Heleen van Haalen
- Global Health Economics and Payer Evidence, BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Katarina Hedman
- Late Cardiovascular, Renal, Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - James A Sloand
- Present affiliation: Division of Kidney Diseases & Hypertension, the George Washington University, Washington, DC, USA.,Global Medical Affairs, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA
| | - Amy Tang
- Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place - 3E, Detroit, MI, 48202, USA
| | - Eric T Wittbrodt
- Cardiovascular, Renal, Metabolism Epidemiology, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA
| | - Jerry Yee
- Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI, USA
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Okamoto N, Inaguma D, Hayashi H, Koseki A, Iwamori T, Kudo M, Yuzawa Y. Prescription rate of erythropoietin-stimulating agents is low for patients with renal impairment under non-nephrology care in a tertiary-level academic medical center in Japan. Clin Exp Nephrol 2022; 26:678-687. [PMID: 35230570 DOI: 10.1007/s10157-022-02194-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/01/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Erythropoiesis-stimulating agents (ESAs) and iron supplements may be prescribed appropriately under nephrology care. However, there are few reports detailing the differences in prescription rates of these therapies among clinical departments. METHODS A total of 39,585 patients with renal impairment were enrolled from a database of 914,280 patients. Patients were selected based on an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m2. There were eight clinical departments from internal medicine, including nephrology. We defined a hemoglobin level less than 11.0 g/dL as anemia and set 20% of transferrin saturation and 100 ng/mL of serum ferritin as cutoff points. We compared the prescription rates of ESAs and iron supplementation based on the hemoglobin level and iron status among the patients seen across the eight clinical departments. RESULTS The lower the eGFR, the more the number of patients seen under nephrology care. The rates of patients with no prescription were 52.3, 39.9, 45.9, and 54.3% among those with hemoglobin levels of < 8, 8 ≤ < 9, 9 ≤ < 10, and 10 ≤ < 11 g/dL, respectively. Of the patients with less than 11.0 g/dL of hemoglobin, 77.3% were prescribed ESAs under nephrology care. Meanwhile, only 18.5 and 8.2% of patients were prescribed ESAs in clinical departments of internal medicine, other than nephrology, and non-internal medicine care, respectively. CONCLUSION Treatment for anemia has not been sufficiently performed in patients with renal impairment under non-nephrology care in a real-world clinical setting.
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Affiliation(s)
- Naoki Okamoto
- Department of Internal Medicine, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya, Aichi, 4548509, Japan
| | - Daijo Inaguma
- Department of Internal Medicine, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya, Aichi, 4548509, Japan.
| | - Hiroki Hayashi
- Department of Nephrology, Fujita Health University, Toyoake, Japan
| | | | | | | | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University, Toyoake, Japan
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Minutolo R, Provenzano M, Chiodini P, Borrelli S, Garofalo C, Andreucci M, Liberti ME, Bellizzi V, Conte G, De Nicola L, De Nicola L, Minutolo R, Zamboli P, Iodice FC, Borrelli S, Chiodini P, Signoriello S, Gallo C, Conte G, Cianciaruso B, Pota A, Nappi F, Avella F, Di Iorio BR, Bellizzi V, Cestaro R, Martignetti V, Morrone L, Lupo A, Abaterusso C, Donadio C, Bonomini M, Sirolli V, Casino F, Lopez T, Detomaso F, Giannattasio M, Virgilio M, Tarantino G, Cristofano C, Tuccillo S, Chimienti S, Petrarulo F, Giancaspro V, Strippoli M, Laraia E, Gallucci M, Gigante B, Lodeserto C, Santese D, Montanaro A, Giordano R, Caglioti A, Fuiano G, Zoccali C, Caridi G, Postorino M, Savica V, Monardo P, Bellinghieri G, Santoro D, Castellino P, Rapisarda F, Fatuzzo P, Messina A, Dal Canton A, Esposito V, Formica M, Segoloni G, Gallieni M, Locatelli F, Tarchini R, Meneghel G, Oldrizzi L, Cossu M, Di Giulio S, Malaguti M, Pizzarelli F, Quintaliani G, Cianciaruso B, Pisani A, Conte G, De Nicola L, Minutolo R, Bonofiglio R, Fuiano G, Grandaliano G, Bellinghieri G, Santoro D, Cianciaruso B, Russo D, Pota A, Di Micco L, Torraca S, Sabbatini M, Pisani A, Bellizzi V. New-Onset Anemia and Associated Risk of ESKD and Death in Non-Dialysis CKD Patients: A Multi-Cohort Observational Study. Clin Kidney J 2022; 15:1120-1128. [PMID: 35664282 PMCID: PMC9155211 DOI: 10.1093/ckj/sfac004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Indexed: 12/03/2022] Open
Abstract
Background Anemia is a common complication of chronic kidney disease (CKD), but its incidence in nephrology settings is poorly investigated. Similarly, the risks of adverse outcomes associated with new-onset anemia are not known. Methods We performed a pooled analysis of three observational cohort studies including 1031 non-anemic CKD patients with eGFR <60 mL/min/1.73 m2 regularly followed in renal clinics. We estimated the incidence of mild anemia (hemoglobin 11–12 g/dL in women and 11–13 g/dL in men) and severe anemia (hemoglobin <11 g/dL or use of erythropoiesis-stimulating agents) during a 3-year follow-up period. Thereafter we estimated the risk of end-stage kidney disease (ESKD) and all-cause death associated with new-onset mild and severe anemia. Results The mean age was 63 ± 14 years, 60% were men and 20% had diabetes. The mean estimated glomerular filtration rate (eGFR) was 37 ± 13 mL/min/1.73 m2 and the median proteinuria was 0.4 g/day [interquartile range (IQR) 0.1–1.1]. The incidence of mild and severe anemia was 13.7/100 patients-year and 6.2/100 patients-year, respectively. Basal predictors of either mild or severe anemia were diabetes, lower hemoglobin, higher serum phosphate, eGFR <30 mL/min/1.73 m2 and proteinuria >0.50 g/day. Male sex, moderate CKD (eGFR 30–44 mL/min/1.73 m2) and moderate proteinuria (0.15–0.50 g/day) predicted only mild anemia. The incidence of anemia increased progressively with CKD stages (from 8.77 to 76.59/100 patients-year) and the proteinuria category (from 13.99 to 25.02/100 patients-year). During a median follow-up of 3.1 years, 232 patients reached ESKD and 135 died. Compared with non-anemic patients, mild anemia was associated with a higher adjusted risk of ESKD {hazard ratio [HR] 1.42 [95% confidence interval (CI) 1.02–1.98]} and all-cause death [HR 1.55 (95% CI 1.04–2.32)]. Severe anemia was associated with an even higher risk of ESKD [HR 1.73 (95% CI 1.20–2.51)] and death [HR 1.83 (95% CI 1.05–3.19)]. Conclusions New-onset anemia is frequent, particularly in patients with more severe renal damage and in those with diabetes mellitus. The occurrence of anemia, even of a mild degree, is associated with mortality risk and faster progression towards ESKD.
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Affiliation(s)
- Roberto Minutolo
- Nephrology Unit at University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Michele Provenzano
- Nephrology Unit, “Magna Graecia”, Department of Health Sciences, “Magna Graecia”, University of Catanzaro, Italy, Catanzaro, Italy
| | - Paolo Chiodini
- Medical Statistics Unit, University of Campania “Luigi Vanvitelli” Naples
| | - Silvio Borrelli
- Nephrology Unit at University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Carlo Garofalo
- Nephrology Unit at University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Michele Andreucci
- Nephrology Unit, “Magna Graecia”, Department of Health Sciences, “Magna Graecia”, University of Catanzaro, Italy, Catanzaro, Italy
| | | | - Vincenzo Bellizzi
- Nephrology Unit, University Hospital “San Giovanni di Dio e Ruggi d'Aragona” in Salerno, Italy
| | - Giuseppe Conte
- Nephrology Unit at University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Luca De Nicola
- Nephrology Unit at University of Campania “Luigi Vanvitelli”, Naples, Italy
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Portolés J, Martín L, Broseta JJ, Cases A. Anemia in Chronic Kidney Disease: From Pathophysiology and Current Treatments, to Future Agents. Front Med (Lausanne) 2021; 8:642296. [PMID: 33842503 PMCID: PMC8032930 DOI: 10.3389/fmed.2021.642296] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/01/2021] [Indexed: 12/19/2022] Open
Abstract
Anemia is a common complication in chronic kidney disease (CKD), and is associated with a reduced quality of life, and an increased morbidity and mortality. The mechanisms involved in anemia associated to CKD are diverse and complex. They include a decrease in endogenous erythropoietin (EPO) production, absolute and/or functional iron deficiency, and inflammation with increased hepcidin levels, among others. Patients are most commonly managed with oral or intravenous iron supplements and with erythropoiesis stimulating agents (ESA). However, these treatments have associated risks, and sometimes are insufficiently effective. Nonetheless, in the last years, there have been some remarkable advances in the treatment of CKD-related anemia, which have raised great expectations. On the one hand, a novel family of drugs has been developed: the hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs). These agents induce, among other effects, an increase in the production of endogenous EPO, improve iron availability and reduce hepcidin levels. Some of them have already received marketing authorization. On the other hand, recent clinical trials have elucidated important aspects of iron supplementation, which may change the treatment targets in the future. This article reviews the current knowledge of the pathophysiology CKD-related anemia, current and future therapies, the trends in patient management and the unmet goals.
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Affiliation(s)
- Jose Portolés
- Department of Nephrology, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
- Anemia Working Group Spanish Society of Nephrology, Madrid, Spain
| | - Leyre Martín
- Department of Nephrology, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
- Anemia Working Group Spanish Society of Nephrology, Madrid, Spain
| | - José Jesús Broseta
- Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Aleix Cases
- Anemia Working Group Spanish Society of Nephrology, Madrid, Spain
- Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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10
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Minutolo R, Berto P, Liberti ME, Peruzzu N, Borrelli S, Netti A, Garofalo C, Conte G, De Nicola L, Del Vecchio L, Locatelli F. Ferric Carboxymatose in Non-Hemodialysis CKD Patients: A Longitudinal Cohort Study. J Clin Med 2021; 10:jcm10061322. [PMID: 33806864 PMCID: PMC8005153 DOI: 10.3390/jcm10061322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/09/2021] [Accepted: 03/20/2021] [Indexed: 11/28/2022] Open
Abstract
No information is available on the efficacy of ferric carboxymaltose (FCM) in real-world CKD patients outside the hemodialysis setting. We prospectively followed 59 non-hemodialysis CKD patients with iron deficient anemia (IDA: hemoglobin <12.0/<13.5 g/dL in women/men and TSAT < 20% and/or ferritin < 100 ng/mL) who were intolerant or non-responders to oral iron. Patients received ferric carboxymaltose (FCM) (single dose of 500 mg) followed by additional doses if iron deficiency persisted. We evaluated efficacy of FCM in terms of increase of hemoglobin, ferritin, and TSAT levels. Direct and indirect costs of FCM were also analyzed in comparison with a hypothetical scenario where same amount of iron as ferric gluconate (FG) was administered intravenously. During the 24 weeks of study, 847 ± 428 mg of FCM per patient were administered. IDA improved after four weeks of FCM and remained stable thereafter. At week-24, mean change (95%CI) from baseline of hemoglobin, ferritin and TSAT were +1.16 g/dL (0.55–1.77), +104 ng/mL (40–168) and +9.5% (5.8–13.2), respectively. These changes were independent from ESA use and clinical setting (non-dialysis CKD, peritoneal dialysis and kidney transplant). Among ESA-treated patients (n = 24), ESA doses significantly decreased by 26% with treatment and stopped either temporarily or persistently in nine patients. FCM, compared to a FG-based scenario, was associated with a cost saving of 288 euros/patient/24 weeks. Saving was the same in ESA users/non-users. Therefore, in non-hemodialysis CKD patients, FCM effectively corrects IDA and allows remarkable cost savings in terms of societal, healthcare and patient perspective.
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Affiliation(s)
- Roberto Minutolo
- Division of Nephrology, University of Campania, Luigi Vanvitelli, 80138 Naples, Italy; (M.E.L.); (N.P.); (S.B.); (A.N.); (C.G.); (G.C.); (L.D.N.)
- Correspondence: ; Tel./Fax: +39-081-2549409
| | | | - Maria Elena Liberti
- Division of Nephrology, University of Campania, Luigi Vanvitelli, 80138 Naples, Italy; (M.E.L.); (N.P.); (S.B.); (A.N.); (C.G.); (G.C.); (L.D.N.)
| | - Nicola Peruzzu
- Division of Nephrology, University of Campania, Luigi Vanvitelli, 80138 Naples, Italy; (M.E.L.); (N.P.); (S.B.); (A.N.); (C.G.); (G.C.); (L.D.N.)
| | - Silvio Borrelli
- Division of Nephrology, University of Campania, Luigi Vanvitelli, 80138 Naples, Italy; (M.E.L.); (N.P.); (S.B.); (A.N.); (C.G.); (G.C.); (L.D.N.)
| | - Antonella Netti
- Division of Nephrology, University of Campania, Luigi Vanvitelli, 80138 Naples, Italy; (M.E.L.); (N.P.); (S.B.); (A.N.); (C.G.); (G.C.); (L.D.N.)
| | - Carlo Garofalo
- Division of Nephrology, University of Campania, Luigi Vanvitelli, 80138 Naples, Italy; (M.E.L.); (N.P.); (S.B.); (A.N.); (C.G.); (G.C.); (L.D.N.)
| | - Giuseppe Conte
- Division of Nephrology, University of Campania, Luigi Vanvitelli, 80138 Naples, Italy; (M.E.L.); (N.P.); (S.B.); (A.N.); (C.G.); (G.C.); (L.D.N.)
| | - Luca De Nicola
- Division of Nephrology, University of Campania, Luigi Vanvitelli, 80138 Naples, Italy; (M.E.L.); (N.P.); (S.B.); (A.N.); (C.G.); (G.C.); (L.D.N.)
| | - Lucia Del Vecchio
- Department of Nephrology and Dialysis, Sant’Anna Hospital, ASST Lariana, 22042 Como, Italy;
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11
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Hao CM, Wittbrodt ET, Palaka E, Guzman N, Dunn A, Grandy S. Understanding Patient Perspectives and Awareness of the Impact and Treatment of Anemia with Chronic Kidney Disease: A Patient Survey in China. Int J Nephrol Renovasc Dis 2021; 14:53-64. [PMID: 33654421 PMCID: PMC7910152 DOI: 10.2147/ijnrd.s291393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/20/2021] [Indexed: 12/16/2022] Open
Abstract
Background Anemia is a common complication of chronic kidney disease (CKD) that may reduce patients’ health-related quality of life (HRQoL). This study explored the experience and knowledge of patients with CKD, with and without anemia, in China. Methods A quantitative online survey was administered to 500 consenting Chinese patient volunteers aged ≥18 years with self-reported CKD, with or without anemia, between August 29, and September 17, 2018. Patients with cancer were excluded. The 27-question survey explored knowledge of anemia, HRQoL, anemia management, and interactions with healthcare providers. Results Of 456 evaluable patients, 148 (32.5%) reported having anemia and 262 (57.5%) did not. Knowledge of anemia and its symptoms varied, and approximately half of all patients did not know their hemoglobin level. Patients with anemia expressed an adverse impact of anemia on HRQoL, most commonly lack of energy (65.5%), sadness/depression (54.1%), and feeling ill (50.0%). The most frequently reported treatments among these patients were dietary advice (68.9%), iron supplements (63.5%), and oral medications (53.4%). Although 89.2% of patients with anemia trusted their healthcare providers above other information sources, only 29.0% reported seeking information from them; this was despite 92.6% reporting wanting further information and support about managing conditions like anemia. Conclusion Our findings suggest that patients with CKD, both with and without anemia, would benefit from increased awareness of anemia and more in-depth discussions with healthcare providers in order to facilitate better management of CKD and optimization of treatment plans.
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Affiliation(s)
- Chuan-Ming Hao
- Fudan University, Huashan Hospital, Shanghai, People's Republic of China
| | - Eric T Wittbrodt
- Biopharmaceuticals Medical Unit, AstraZeneca, Gaithersburg, MD, USA
| | - Eirini Palaka
- Biopharmaceuticals Global Market Access, AstraZeneca, Cambridge, UK
| | - Nicolas Guzman
- Global Medicines Development, AstraZeneca, Gaithersburg, MD, USA
| | - Alicia Dunn
- AstraZeneca Global Corporate Affairs Gaithersburg, Gaithersburg, MD, USA
| | - Susan Grandy
- Biopharmaceuticals Global Market Access, AstraZeneca, Gaithersburg, MD, USA
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12
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Fishbane S, El-Shahawy MA, Pecoits-Filho R, Van BP, Houser MT, Frison L, Little DJ, Guzman NJ, Pergola PE. Roxadustat for Treating Anemia in Patients with CKD Not on Dialysis: Results from a Randomized Phase 3 Study. J Am Soc Nephrol 2021; 32:737-755. [PMID: 33568383 PMCID: PMC7920165 DOI: 10.1681/asn.2020081150] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 12/01/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Current anemia therapies for patients with non-dialysis-dependent CKD may require injection and medical visits. Roxadustat, an oral hypoxia-inducible factor prolyl hydroxylase inhibitor, stimulates erythropoiesis and improves iron homeostasis. METHODS In this double-blind phase 3 study, we randomized patients with non-dialysis-dependent CKD stages 3-5 and hemoglobin <10.0 g/dl (1:1) to thrice-weekly 70-mg oral roxadustat or placebo. Doses were titrated throughout the study based on hemoglobin levels. The primary efficacy end point was mean change from baseline in hemoglobin averaged over weeks 28-52 versus placebo, irrespective of rescue therapy use. We assessed patients for adverse events. RESULTS The study included 2781 patients, 1393 who received roxadustat and 1388 who received placebo. Mean baseline hemoglobin was 9.1 g/dl for both groups. The mean change in hemoglobin from baseline was 1.75 g/dl (95% confidence interval [95% CI], 1.68 to 1.81) with roxadustat versus 0.40 g/dl (95% CI, 0.33 to 0.47) with placebo, (P<0.001). Among 411 patients with baseline elevated high-sensitivity C-reactive protein, mean change in hemoglobin from baseline was 1.75 g/dl (95% CI, 1.58 to 1.92) with roxadustat versus 0.62 g/dl (95% CI, 0.44 to 0.80) with placebo, (P<0.001). Roxadustat reduced the risk of red blood cell transfusion by 63% (hazard ratio, 0.37; 95% CI, 0.30 to 0.44). The most common adverse events with roxadustat and placebo, respectively, were ESKD (21.0% versus 20.5%), urinary tract infection (12.8% versus 8.0%), pneumonia (11.9% versus 9.4%), and hypertension (11.5% versus 9.1%). CONCLUSIONS Roxadustat effectively increased hemoglobin in patients with non-dialysis-dependent CKD and reduced the need for red blood cell transfusion, with an adverse event profile comparable to that of placebo. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Safety and Efficacy Study of Roxadustat to Treat Anemia in Patients With CKD, Not on Dialysis, NCT02174627.
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Affiliation(s)
- Steven Fishbane
- Department of Medicine, Zucker School of Medicine at Hofstra/Northwell Health, Great Neck, New York
| | - Mohamed A. El-Shahawy
- Department of Medicine, Keck-University of Southern California School of Medicine, Los Angeles, California
| | - Roberto Pecoits-Filho
- School of Medicine, Pontifical Catholic University of Parana, Curitiba, Brazil,Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Bui Pham Van
- Department of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Mark T. Houser
- Global Medicines Development, Biopharmaceuticals Research & Development, AstraZeneca Gaithersburg, Gaithersburg, Maryland
| | - Lars Frison
- Biostatistics, Biopharmaceuticals Research & Development, AstraZeneca Gothenburg, Mölndal, Sweden
| | - Dustin J. Little
- Global Medicines Development, Biopharmaceuticals Research & Development, AstraZeneca Gaithersburg, Gaithersburg, Maryland
| | - Nicolas J. Guzman
- Global Medicines Development, Biopharmaceuticals Research & Development, AstraZeneca Gaithersburg, Gaithersburg, Maryland
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ESA, Iron Therapy and New Drugs: Are There New Perspectives in the Treatment of Anaemia? J Clin Med 2021; 10:jcm10040839. [PMID: 33670704 PMCID: PMC7922992 DOI: 10.3390/jcm10040839] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 02/07/2023] Open
Abstract
Anemia is a well-known consequence of chronic kidney disease (CKD); it is mainly due to a relative insufficiency of erythropoietin synthesis by the failing kidneys. Over the years, the combination of erythropoiesis stimulating agents (ESA) and iron has become the standard of care of anemia. All ESAs effectively increase hemoglobin (Hb) levels in a substantial percentage of patients. However, in the last decade, their use has been surrounded by safety issues in increased cardiovascular risk, especially when used at high doses in inflamed and hyporesponsive patients. This has led to the definition of a more cautious Hb target. Iron deficiency is very frequent in CKD patients, with a higher frequency in non-dialysis patients. Traditionally, iron supplementation is mostly used as supportive therapy for anemia control. However, the concept is growing that intravenous iron therapy per se could be beneficial in the presence of heart failure. A new class of drugs, prolyl hydroxylase domain (PHD) inhibitors (PHD inhibitors) is becoming available for the treatment of anemia in CKD patients. Theoretically, these agents have a number of advantages, the main ones being that of stimulating the synthesis of endogenous erythropoietin and increasing iron availability. The impact of their future use in clinical practice is still to be defined. Another possible strategy could be targeting serum hepcidin and its related pathways. This possibility is fascinating from the scientific point of view, but at present its development phase is still far from clinical application.
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Matsumura K, Okumiya T, Sugiura T, Takahashi N, Yamamoto Y, Kikuchi S, Fujii K, Otagaki M, Shiojima I. Shortened red blood cell age in patients with end-stage renal disease who were receiving haemodialysis: a cross-sectional study. BMC Nephrol 2020; 21:418. [PMID: 32993543 PMCID: PMC7526359 DOI: 10.1186/s12882-020-02078-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/23/2020] [Indexed: 12/30/2022] Open
Abstract
Background The causes of anaemia in patients with end-stage renal disease include a relative deficiency in erythropoietin production and complex clinical conditions. We aimed to investigate the underlying mechanisms of anaemia in patients with end-stage renal disease who were undergoing maintenance dialysis by measuring erythrocyte creatine levels. Methods In a cross-sectional study, we evaluated 69 patients with end-stage renal disease who were receiving haemodialysis (n = 55) or peritoneal dialysis (n = 14). Erythrocyte creatine level, a quantitative marker of mean red blood cell (RBC) age, was measured. Results The mean RBC age was significantly shorter in the haemodialysis group than in the peritoneal dialysis group (47.7 days vs. 59.8 days, p < 0.0001), although the haemoglobin levels were comparable between the groups. A Spearman correlation coefficient analysis revealed that shortened RBC age positively correlated with transferrin saturation (r = 0.54), ferritin level (r = 0.47), and haptoglobin level (r = 0.39) but inversely related with reticulocyte (r = − 0.36), weekly doses of erythropoiesis-stimulating agents (ESAs; r = − 0.62), erythropoietin resistance index (r = − 0.64), and intradialytic ultrafiltration rate (r = − 0.32). Conclusions Shortened RBC age was observed in patients who were receiving maintenance haemodialysis and was associated with iron deficiency, greater haptoglobin consumption, higher ESA requirements, and poor erythropoietin responsiveness, as well as with greater intradialytic fluid extraction.
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Affiliation(s)
- Koichiro Matsumura
- Department of Medicine II, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, 5708507, Japan.
| | - Toshika Okumiya
- Department of Biomedical Laboratory Sciences, Faculty of Health Sciences, Kumamoto University, Kumamoto, Japan
| | - Tetsuro Sugiura
- Department of Medicine II, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, 5708507, Japan
| | - Nobuyuki Takahashi
- Department of Medicine II, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, 5708507, Japan
| | - Yoshihiro Yamamoto
- Department of Medicine II, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, 5708507, Japan
| | - Sanae Kikuchi
- Department of Medicine II, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, 5708507, Japan
| | - Kenichi Fujii
- Department of Medicine II, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, 5708507, Japan
| | - Munemitsu Otagaki
- Department of Medicine II, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, 5708507, Japan
| | - Ichiro Shiojima
- Department of Medicine II, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, 5708507, Japan
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Sofue T, Nakagawa N, Kanda E, Nagasu H, Matsushita K, Nangaku M, Maruyama S, Wada T, Terada Y, Yamagata K, Narita I, Yanagita M, Sugiyama H, Shigematsu T, Ito T, Tamura K, Isaka Y, Okada H, Tsuruya K, Yokoyama H, Nakashima N, Kataoka H, Ohe K, Okada M, Kashihara N. Prevalence of anemia in patients with chronic kidney disease in Japan: A nationwide, cross-sectional cohort study using data from the Japan Chronic Kidney Disease Database (J-CKD-DB). PLoS One 2020; 15:e0236132. [PMID: 32687544 PMCID: PMC7371174 DOI: 10.1371/journal.pone.0236132] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/29/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The Japan Chronic Kidney Disease Database (J-CKD-DB) is a nationwide clinical database of patients with chronic kidney disease (CKD) based on electronic health records. The objective of this study was to assess the prevalence of anemia and the utilization rate of erythropoiesis-stimulating agents (ESAs) in Japanese patients with CKD. METHODS In total, 31,082 adult outpatients with estimated glomerular filtration rates of 5-60 ml/min/1.73 m2 in seven university hospitals were included this analysis. The proportions of patients with CKD stages G3b, G4, and G5 were 23.5%, 7.6%, and 3.1%, respectively. RESULTS The mean (standard deviation) hemoglobin level of male patients was 13.6 (1.9) g/dl, which was significantly higher than the mean hemoglobin level of female patients (12.4 (1.6) g/dl). The mean (standard deviation) hemoglobin levels were 11.4 (2.1) g/dl in patients with CKD stage G4 and 11.2 (1.8) g/dl in patients with CKD stage G5. The prevalences of anemia were 40.1% in patients with CKD stage G4 and 60.3% in patients with CKD stage G5. Logistic regression analysis showed that diagnoses of CKD stage G3b (adjusted odds ratio [95% confidence interval]: 2.32 [2.09-2.58]), G4 (5.50 [4.80-6.31]), and G5 (9.75 [8.13-11.7]) were associated with increased prevalence of anemia. The utilization rates of ESAs were 7.9% in patients with CKD stage G4 and 22.4% in patients with CKD stage G5. CONCLUSIONS We determined the prevalence of anemia and utilization rate of ESAs in Japanese patients with CKD using data from a nationwide cohort study.
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Affiliation(s)
- Tadashi Sofue
- Division of Nephrology and Dialysis, Department of Cardiorenal and Cerebrovascular Medicine, Kagawa University, Kagawa, Japan
- * E-mail:
| | - Naoki Nakagawa
- Division of Cardiology, Nephrology, Respiratory and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Eiichiro Kanda
- Medical Science, Kawasaki Medical School, Kurashiki, Japan
| | - Hajime Nagasu
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Shoichi Maruyama
- Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Wada
- Division of Nephrology, Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Yoshio Terada
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Kunihiro Yamagata
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Motoko Yanagita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hitoshi Sugiyama
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takashi Shigematsu
- Division of Nephrology, Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takafumi Ito
- Division of Nephrology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hirokazu Okada
- Department of Nephrology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Kazuhiko Tsuruya
- Department of Integrated Therapy for Chronic Kidney Disease, Kyushu University, Fukuoka, Japan
- Department of Nephrology, Nara Medical University, Kashihara, Japan
| | - Hitoshi Yokoyama
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Naoki Nakashima
- Department of Advanced Information Technology, Kyushu University, Fukuoka, Japan
| | - Hiromi Kataoka
- Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Kazuhiko Ohe
- Department of Healthcare Information Management, The University of Tokyo Hospital, Tokyo, Japan
| | - Mihoko Okada
- Institute of Health Data Infrastructure for All, Tokyo, Japan
| | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
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George S, McCann M. A nurse prescriber-led protocol for anaemia management in established haemodialysis patients: A retrospective study. J Clin Nurs 2020; 29:2535-2543. [PMID: 32267027 DOI: 10.1111/jocn.15275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/27/2020] [Accepted: 03/23/2020] [Indexed: 12/26/2022]
Abstract
AIM AND OBJECTIVE To evaluate the impact of a nurse prescriber-led protocol compared to a traditional physician-led nonprotocol-based approach had on maintaining targeted haemoglobin levels in patients on maintenance haemodialysis. BACKGROUND Anaemia is a common complication of chronic kidney disease and has a profound impact on the patients' well-being. Current practices place a greater emphasis on the decision-making role of nurses in renal anaemia management. The introduction of nurse prescribing in this area is a relatively new concept. DESIGN A retrospective cohort design, covering an eight-month period pre- and post introduction of a nurse prescriber-led anaemia protocol; study adheres to the STROBE Statement. METHODS Using a nonprobability convenience sample, data extracted from the medical records and electronic patient records system (eMed) related to 74 patients at a single outpatient haemodialysis centre located within an acute general teaching hospital. The primary outcome was patients' haemoglobin level pre- and post introduction of the protocol. Secondary outcomes included erythropoietin-stimulating agent and iron dosage, and serum ferritin and transferrin saturation levels. RESULTS There were no statistically significant differences between pre- and post protocol serum haemoglobin level and erythropoietin-stimulating agent dosage. Under the management of the nurse prescriber, patients experienced a significant improvement in serum ferritin and transferrin saturation levels and required significantly less intravenous iron dosage. CONCLUSIONS This study, the first of its kind, found that patients receiving haemodialysis experience a significant improvement in iron indices while receiving a significantly lower amount of intravenous iron when managed by a nurse prescriber. Furthermore, the nurse prescribers' decision-making capacity is as effective as a physician-led nonprotocol-based approach in achieving haemoglobin target levels. RELEVANCE TO CLINICAL PRACTICE Nurse prescribers have a role in implementing a safe, standardised and sustained approach to anaemia management in outpatient haemodialysis settings without compromising patient care.
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Affiliation(s)
- Sani George
- Haemodialysis Unit, Midlands Regional Hospital, Tullamore, Ireland
| | - Margaret McCann
- School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland
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Awan AA, Walther CP, Richardson PA, Shah M, Winkelmayer WC, Navaneethan SD. Prevalence, correlates and outcomes of absolute and functional iron deficiency anemia in nondialysis-dependent chronic kidney disease. Nephrol Dial Transplant 2019; 36:129-136. [DOI: 10.1093/ndt/gfz192] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Anemia is associated with adverse outcomes in those with chronic kidney disease (CKD). We examined the association of absolute and functional iron deficiency anemia (IDA) with adverse outcomes (cardiovascular hospitalization, dialysis and mortality) in those with nondialysis-dependent CKD.
Methods
Nondialysis-dependent CKD patients followed in the US Veterans Administration with hemoglobin level measured within 90 days of the date of the second estimated glomerular filtration rate <60 mL/min/1.73 m2 were included. Logistic regression, multivariate Cox proportional hazards and Poisson regression models adjusted for demographics and comorbidities were used to assess the prevalence and correlates of absolute [transferrin saturation (TSAT) ≤20%, ferritin <100 ng/mL] and functional (TSA T≤20%, ferritin >100–500 ng/mL) IDA and the associations of absolute and functional IDA with mortality, dialysis and cardiovascular hospitalization.
Results
Of 933 463 patients with CKD, 20.6% had anemia. Among those with anemia, 23.6% of patients had both TSAT and ferritin level measured, of whom 30% had absolute IDA and 19% had functional IDA. Absolute IDA in CKD was not associated with an increased risk of mortality or dialysis but was associated with a higher risk of 1-year {risk ratio [RR] 1.20 [95% confidence interval (CI) 1.12–1.28]} and 2-year cardiovascular hospitalization [RR 1.11 (95% CI 1.05–1.17)]. CKD patients with functional IDA had a higher risk of mortality [hazard ratio (HR) 1.11 (95% CI 1.07–1.14)] along with a higher risk of 1-year [RR 1.21 (95% CI 1.1–1.30)] and 2-year cardiovascular hospitalization [RR 1.13 (95% CI 1.07–1.21)]. Ferritin >500 ng/mL (treated as a separate category) was only associated with an increased risk of mortality [HR 1.38 (95% CI 1.26–1.51)].
Conclusions
In a large population of CKD patients with anemia, absolute and functional IDA were associated with various clinical covariates. Functional IDA was associated with an increased risk of mortality and cardiovascular hospitalization, but absolute IDA was associated only with a higher risk of hospitalization.
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Affiliation(s)
- Ahmed A Awan
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Carl P Walther
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Peter A Richardson
- Center for Innovation in Quality Effectiveness & Safety, Michael E. Debakey VA Medican Center, Houston, TX, USA
| | - Maulin Shah
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovation in Quality Effectiveness & Safety, Michael E. Debakey VA Medican Center, Houston, TX, USA
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Sankar D Navaneethan
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovation in Quality Effectiveness & Safety, Michael E. Debakey VA Medican Center, Houston, TX, USA
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