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Abstract: SA-PO237

CKD Anemia Epidemiology and Associated Outcomes in Non-Dialysis-Dependent Patients

Session Information

Category: Anemia and Iron Metabolism

  • 202 Anemia and Iron Metabolism: Clinical

Authors

  • Lamerato, Lois, Henry Ford Health System, Detroit, Michigan, United States
  • James, Glen, AstraZeneca, Cambridge, United Kingdom
  • van Haalen, Heleen, AstraZeneca, Gothenburg, Sweden
  • Hedman, Katarina, AstraZeneca, Gothenburg, Sweden
  • Sloand, James A., AstraZeneca, Gaithersburg, Maryland, United States
  • Yee, Jerry, Henry Ford Health System, Detroit, Michigan, United States
  • Wittbrodt, Eric T., AstraZeneca, Gaithersburg, Maryland, United States
Background

Anemia is a well-known CKD complication associated with increased risk of red cell transfusions (RBCs), low quality of life, and adverse outcomes such as cardiovascular events and mortality. Current treatments including erythropoietin-stimulating agents (ESAs) have not been shown to improve clinical outcomes in non-dialysis dependent (NDD) CKD patients. The aim of this study was to generate real-world evidence regarding the epidemiology and selected clinical outcomes of anemia and in NDD patients.

Methods

Data for this retrospective, observational study was extracted from Henry Ford Health System databases. Adults with NDD CKD (estimated GFR <60 ml/min/1.73m2) between 01/01/13 to 12/31/17 were identified. Patients on renal replacement therapy or with active cancer were excluded. All patients were followed for ≥12 months and until 12/31/18. Outcomes included composites for CKD progression (end-stage CKD, 40% decrease in eGFR, CKD stage advancement, and doubling of serum creatinine) and major cardiovascular events (MACE). Logistic regression models, adjusted for baseline demographics and anemia, identified factors associated with MACE at 1 and 5 y.

Results

Study cohort (N = 55,447) demographics: median age 73 y (IQR 64, 82); 56% female; 63% White, 27% African American (AA), 2% Hispanic, 1% Asian, and 7% other/unknown race. Index CKD stages: 3A (60%), 3B (27%), 4 (10%), and 5 (3%). Baseline anemia prevalence, defined as Hb <10 g/dl, was 25%. Anemia treatments included iron (10%), RBCs (4%), and ESAs (1%). The 1- and 5-y cumulative incidences of CKD progression were 43% and 67%, respectively; for MACE, 8% and 37%, respectively. Baseline anemia (odds ratio (OR) 1.90) and AA race (OR 1.10) were associated with CKD progression risk at 1 y; both p <0.01. Both factors and strata of increasing age were modestly associated with CKD progression at 5 y. Increased risks of 1- and 5-y MACE were associated with baseline anemia (OR 3.22 and 3.02, respectively), male sex (OR 1.29 and 1.30, respectively), and increasing age (OR 1.32 and 1.50, respectively); all p <0.01, while AA race was slightly protective for 5-y MACE (OR 0.92, p <0.05).

Conclusion

Anemia is highly prevalent in NDD CKD patients, with a low frequency of treatment. Serum Hb <10 g/dL was associated with increased risk of CKD progression and MACE.

Funding

  • Commercial Support – AstraZeneca