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Abstract: PO0287

Treatment Pathways of Non-Dialysis-Dependent CKD Patients with Anemia: A Report from the DISCOVER CKD Retrospective Cohort

Session Information

Category: Anemia and Iron Metabolism

  • No subcategory defined

Authors

  • Wittbrodt, Eric T., AstraZeneca, Gaithersburg, Maryland, United States
  • Carrero, Juan Jesus, Karolinska Institutet, Stockholm, Stockholm, Sweden
  • James, Glen, AstraZeneca UK Ltd, Cambridge, Cambridgeshire, United Kingdom
  • Fishbane, Steven, Northwell, Manhasset, New York, United States
  • Kumar, Supriya R., AstraZeneca, Gaithersburg, Maryland, United States
  • Pecoits-Filho, Roberto, Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil
  • Garcia Sanchez, Juan Jose, AstraZeneca UK Ltd, Cambridge, Cambridgeshire, United Kingdom
  • Pollock, Carol A., University of Sydney, Sydney, New South Wales, Australia
  • Sloand, James A., AstraZeneca, Gaithersburg, Maryland, United States
  • Hedman, Katarina, AstraZeneca, Gothenburg, Sweden
  • Wheeler, David C., University College London, London, London, United Kingdom
Background

Anemia is a frequent complication of chronic kidney disease (CKD), yet most patients experiencing this problem remain untreated until the initiation of renal replacement therapy. We describe treatment pathways of key medications prescribed to non-dialysis dependent (NDD) CKD patients with anemia in DISCOVER CKD.

Methods

Patients included in this analysis were extracted from the Limited Claims and EHR (LCED) data. The study cohort included patients aged >18 years with 2 estimate glomerular filtration rate (eGFR) measures <60 mL/min/1.73m2 >90 days apart between January 2008 and September 2018. The index date was the first Hb measure (<12 g/dL [females], <13 g/dL [males] per WHO criteria), or an anemia therapy (iron, ESA or blood transfusion) prescription after the 2nd eGFR measure. Exclusion criteria were: <1-year registration/medical history prior to index, active bleeding in the 30 days preceding and inclusive of index, an Hb value (only) within 30 days from transfusion or bleeding and no Hb measure within a year after CKD diagnosis. Oral iron was incompletely captured in LCED. Sankey Plots were used to visualize chronological treatment pathways (1st to 3rd line) post-index of key treatments commonly prescribed to CKD patients with anemia including: oral iron, IV Iron, ESA and blood transfusion.

Results

Preliminarily, 1446 (2.6% of anemia base cohort) patients were prescribed anemia therapies during follow-up, with IV iron (32.5%), transfusions (30.5%), ESA (21.6%), oral iron (12.2%) and ESA+IV Iron (2.7%) used as 1st-line therapies, Figure 1. Median times to 1st-line therapy initiation after index were: 108 days for oral iron, 194 days for ESA, 197 days for IV iron, and 244 days for blood transfusion.

Conclusion

In routine clinical care, anemia in NDD CKD is under treated and rescue therapies are used for anemia more often than preventive therapies.