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Abstract: TH-PO251

Incidence, Prevalence, and Correlates of Anemia and Iron Deficiency in US Veterans with Non-Dialysis Dependent CKD (NDD-CKD)

Session Information

Category: Anemia and Iron Metabolism

  • 202 Anemia and Iron Metabolism: Clinical

Authors

  • Walther, Carl P., Baylor College of Medicine , Houston, Texas, United States
  • Richardson, Peter, Baylor College of Medicine , Houston, Texas, United States
  • Shah, Maulin, Baylor College of Medicine , Houston, Texas, United States
  • Mandayam, Sreedhar A., Baylor College of Medicine , Houston, Texas, United States
  • Winkelmayer, Wolfgang C., Baylor College of Medicine , Houston, Texas, United States
  • Navaneethan, Sankar D., Baylor College of Medicine , Houston, Texas, United States
Background

Anemia in CKD is often multifactorial, including from low erythropoietin production, absolute (true) iron deficiency, and functional iron deficiency related to a chronic inflammatory state. However, there is limited evidence regarding the incidence, prevalence, and correlates of anemia and iron deficiency in NDD-CKD, which is the objective of this study.

Methods

We identified persons with NDD-CKD receiving care through the Veterans Affairs healthcare system from 2005-2015. Eligible patients had ≥2 eGFRs <60ml/min/1.73m2 separate by >90 days and a Hgb measured within 180 days of the 2nd measured eGFR. We calculated incidence and prevalence of anemia (Hgb<12g/dl), characterized concurrent iron parameters (iron deficiency: absolute, transferrin saturation [TSAT] ≤20% and ferritin <100ng/ml; functional, TSAT ≤20% and ferritin ≥100ng/ml), and identified correlates of iron deficiency status using logistic regression.

Results

We included 944,175 persons with NDD-CKD and measured Hgb. At incident eGFR <60, 78.4% were non-anemic, 16.9% had mild (Hgb 10-<12g/dl), 4% moderate (Hgb 8-<10g/dl), and 0.6% severe anemia (Hgb <8g/dl). Incidence of anemia among 686,649 at-risk patients was 110.3 (95%CI; 109.9-110.7) per 1000 patient years. Iron parameter measurement varied with presence and severity of anemia: the proportion with both transferrin saturation and ferritin varied from 37.1% in the severely anemic, to 5.2% among those without anemia (Table). In the multivariable analysis, the only significant predictor of absolute iron deficiency anemia was prior GI bleed, and there were no significant predictors of functional iron deficiency.

Conclusion

One in five patients had anemia at CKD diagnosis; among those without it, 11 of 100 developed it for each year of follow-up. Prevalence of both absolute and functional iron deficiency increased with severity of anemia at incident CKD. Outcomes associated with absolute and functional iron deficiency anemia merit further studies.

Funding

  • Commercial Support