Kidney Week

Abstract: TH-PO255

Estimated Glomerular Filtration Rate (eGFR) and Hemoglobin (Hb) Levels Associated with Anemia Therapy in CKD Patients in a US Commercial Insured/Medicare Advantage Population

Session Information

• Anemia and Iron Metabolism: Clinical
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Anemia and Iron Metabolism

• 201 Anemia and Iron Metabolism: Basic

Authors

• Chung, Haechung, HealthCore Inc., Wimlington, Delaware, United States

Haechung Chung,

• Catini, Julia, AstraZeneca, Gaithersburg, Maryland, United States

Julia Catini,

• Kabadi, Shaum, AstraZeneca, Gaithersburg, Maryland, United States

Shaum Kabadi,

• Willey, Vincent, HealthCore Inc., Wimlington, Delaware, United States

Vincent Willey,

Background

Little is known about the eGFR and Hb levels that trigger initiation of anemia treatment in non-dialysis-dependent CKD patients in the real-world setting. The study objective was to explore Hb and eGFR levels prior to anemia treatment in non-dialysis CKD patients and assess the trigger for anemia treatment based on these test results.

Methods

CKD patients treated for anemia were identified in the HealthCore Integrated Research Database from 1/1/07 to 6/30/15 by the presence of ≥ 1 medical claim each with a CKD and anemia diagnosis. Patients were required to have ≥ 12 months of health plan eligibility prior to their first CKD claim, during which they could not have any claims for CKD or anemia. These patients were 1:1 propensity score matched to CKD patients not treated for anemia. An anemia “at-risk” period was defined as the period between the first CKD diagnosis and anemia treatment date or “pseudo” treatment date assigned to the untreated group. Patients in both groups had an eGFR during the at risk-period and an Hb outpatient result within 90 days prior to treatment/pseudo treatment date. Hb and eGFR levels associated with anemia treatment were evaluated; trigger values were assessed using logistic regression with Youden’s J index.

Results

We identified a total of 1724 matched pairs (anemia treated/untreated), with a mean age of 65 years. Anemia treatments included darbepoetin (9.6%), epoetin (24.8%), prescription iron (31.6%) and blood transfusion (60.9%). The mean Hb during the at-risk period was 10.0 and 12.5 g/dL for the anemia treated/untreated cohorts. The mean eGFR during the at-risk period was 41.0 and 52.5 mL/min for the anemia treated/untreated cohorts, with 1/3 of patients in the treated group at stage 4/5 CKD and another 1/3 at stage 3b. The trigger point for anemia treatment was 10.3 g/dL for Hb and 33.3 mL/min/1.73 m² for eGFR, with Hb being a stronger predictor of anemia treatment than eGFR. Type of anemia treatment received depended on Hb level.

Conclusion

Two thirds of patients in the anemia-treated group were stage 3b CKD or worse when treatment was initiated, with Hb being the main impetus for therapy. Future research on the interplay among renal function, Hb levels, and anemia treatment initiation is warranted.

Funding

• Commercial Support –