Abstract: PO0279
Prevalence of Anemia and Associated Erythropoiesis-Stimulating Agent Use in 5.9 Million Non-Dialysis CKD Patients
Session Information
- Anemia and Iron Management
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 200 Anemia and Iron Metabolism
Authors
- Farrington, Danielle Kacie, Johns Hopkins Medicine, Baltimore, Maryland, United States
- Sang, Yingying, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
- Grams, Morgan, Johns Hopkins Medicine, Baltimore, Maryland, United States
- Ballew, Shoshana, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
- Dunning, Stephan C., OptumLabs, Cambridge, Massachusetts, United States
- Stempniewicz, Nikita, American Medical Group Association, Alexandria, Virginia, United States
- Coresh, Josef, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
Background
Chronic kidney disease (CKD) leads to anemia through erythropoietin deficiency and resistance, and a heightened inflammatory state. Characterizing the burden and factors associated with severe anemia (hemoglobin < 10 g/dL) is of particular interest since treatment with erythropoiesis-stimulating agents (ESAs) or other therapies is often considered at this level.
Methods
We analyzed patients in the OptumLabs® Data Warehouse, which contains de-identified claims and electronic health record data, with a complete blood count and serum creatinine measured within 30 days of each other in 2016. Patients requiring dialysis were excluded. We examined the association between low hemoglobin (Hb) categories (<9 g/dL, 9-10 g/dL, 10-11 g/dL) and age, sex, diabetes, history of cardiovascular disease (CVD), and categories of eGFR using polychotomous logistic regression to estimate adjusted relative risk ratios (RRR).
Results
Among 5,875,383 patients in 52 centers, mean age was 56 years (SD 17), and 42% were male. The prevalence of Hb <10 g/dL in CKD stages G1-2, G3a, G3b, G4 and G5 was 2.0%, 4.2%, 9.2%, 20.3% and 36.1%, respectively. Lower eGFR categories were strongly associated with increased risk of anemia, even after adjustment for female sex (RRR 2.6-3.9), diabetes (RRR 1.4-1.8), history of CVD (RRR 1.7-1.9), and age (RRR 2.2-2.4 for age 75+). The frequency of ESA use in patients with hemoglobin <10 g/dL was 0.24%, 0.41%. 0.96%, and 1.0% in CKD stage G3a, 3b, 4 and 5.
Conclusion
Severe anemia was common and strongly associated with low GFR, female sex, older age, diabetes and history of CVD in a wide range of health care systems. ESA use in non-dialysis CKD patients was very uncommon.
Funding
- Private Foundation Support