Abstract: SA-PO255
Contemporary Management of Anemia and Associated Risk Across the Spectrum of CKD: A Nationwide Analysis from the Swedish Renal Registry
Session Information
- Anemia and Iron Metabolism: Clinical
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 202 Anemia and Iron Metabolism: Clinical
Authors
- Evans, Marie, Karolinska Institute, Stockholm, Sweden
- Bower, Hannah, Karolinska Institute, Stockholm, Sweden
- Cockburn, Elinor, Astellas Pharma A/S, Kastrup, Denmark
- Jacobson, Stefan H., Danderyd Hospital, Stockholm, Sweden
- Barany, Peter F., Karolinska Institute, Stockholm, Sweden
- Carrero, Juan Jesus, Karolinska Institute, Stockholm, Sweden
Background
The last decade has seen noteworthy changes in renal anemia guidelines. Here we explore the current management of renal anemia and associated cardiovascular (CV) risk in a contemporary nationwide cohort of chronic kidney disease (CKD) patients in Sweden.
Methods
Observational analysis from the Swedish Renal Registry, including nephrologist-referred adult CKD patients during 2015. The epidemiology and treatment of anemia across the spectrum of stage 3b-5 non–dialysis-dependent (NDD) and dialysis-dependent (DD) CKD were assessed. Logistic regression and Cox proportional hazard models were employed to explore the associations between anemia management, C-reactive protein (CRP), erythropoietin resistance index (ERI; [erythropoiesis-stimulating agent (ESA) dose/weight]/hemoglobin [Hb]), and subsequent risk of major adverse CV events.
Results
Data from 14,415 (NDD, 11,370; DD, 3,045) patients were included. Approximately 60% of NDD CKD patients had anemia (World Health Organization definition: Hb <12 g/dL for females; Hb <13 g/dL for males) compared with 93% of DD patients. The proportions of NDD patients who received iron (oral or intravenous) and/or ESA therapy were 21% and 24%, respectively; the proportions of DD patients were 62% and 82%, respectively. In both NDD and DD populations, about half of the patients receiving ESA had Hb levels between 10-12 g/dL; 27% had Hb >12 g/dL and 14% had Hb <10 g/dL. Use of high-dose ESA (>6000 IU/week) was relatively common even among patients at earlier stages of CKD (~25%). The use of high versus low (<3000 IU/week)/medium (3000-6000 IU/week) dose ESA was associated with increased systemic inflammation in cross-section (CRP >5 mg/L) (odds ratio, 1.68 [95% CI: 1.45-1.94]), with a 40% higher risk of CV events (adjusted hazard ratio [HR], 1.40 [95% CI: 1.16-1.69]). Patients with high (0.81-12.0) versus low (0-0.4) ERI had a 2-fold higher risk of CV events (adjusted HR, 1.98 [95% CI: 1.61-2.43]). Treatment with iron was not associated with CRP levels or CV risk.
Conclusion
Anemia continues to be a highly prevalent complication among contemporary adults with CKD. Given the guideline recommendations, the use of iron was unexpectedly low. High doses of ESA and high ERI predicted increased CRP levels and subsequent CV risk.
Funding
- Commercial Support – Astellas Pharma Inc