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Kidney Week

Abstract: PO0473

The Effect of a Patient Blood Management Program on Renal Outcome in Patients with CKD

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism

Authors

  • Min, Hyeon-Jin, Korea University Medical Center, Seoul, Korea (the Republic of)
  • Kim, Tae-bum, Korea University Medical Center, Seoul, Korea (the Republic of)
  • Son, Young-Bin, Korea University Medical Center, Seoul, Korea (the Republic of)
  • Lee, Jonghyun, Korea University Medical Center, Seoul, Korea (the Republic of)
  • Yang, Jihyun, Korea University Medical Center, Seoul, Korea (the Republic of)
  • Kim, Myung-Gyu, Korea University Medical Center, Seoul, Korea (the Republic of)
  • Jo, Sang-Kyung, Korea University Medical Center, Seoul, Korea (the Republic of)
  • Cho, Won-Yong, Korea University Medical Center, Seoul, Korea (the Republic of)
  • Oh, Sewon, Korea University Medical Center, Seoul, Korea (the Republic of)

Group or Team Name

  • Division of Nephrology, Department of Internal Medicine, Korea University Anam Medical Center
Background

Transfusion burden is high in CKD patients to treat anemia. However, transfusions had risks including volume overload, alloimmunization, blood stream infections and thromboembolism. We evaluated the effect of a monitoring program to identify appropriate transfusions in CKD patients.

Methods

Based on the guidelines of the Korean Society of Blood Transfusion, Korea University Anam Medical Center developed a verification program to assess the adequate indication of transfusion (patient blood management(PBM)) in August 2018. We analyzed 1,192 CKD patients admitted to the department of nephrology from August 2016 to July 2020. Patients were divided into two groups: patients who admitted before the implementation of PBM (pre-PBM(n=592)) and after the implementation of PBM (post-PBM(n=600)).

Results

The amount of blood transfused was 628 units in pre-PBM group and 443 units in post-PBM group. The patients who received more than 2 units was significantly lower in post-PBM group (20.1% vs. 13.5%, p=0.002). There were no differences in the administered doses of erythropoietin and iron between the groups. Although hemoglobin(Hb) (10.5±2.0 vs. 10.3±2.2) were not different between the two groups at admission, Hb levels were significantly lower in post-PBM group at discharge (10.4±1.8 vs. 10.1±2.0, p=0.010) and 6 months after admission (11.5±1.9 vs. 11.1±2.0, p=0.007). Kaplan-Meier analysis showed a survival benefit of CKD progression (≥50% increase in serum creatinine) (p<0.001) and percutaneous coronary intervention (p=0.030) in the post-PBM group. The incidence of end stage kidney disease or mortality was not different between groups. In multivariate analysis, PBM was associated with lower risk for CKD progression (HR of 0.587; 95% CI 0.416-0.830).

Conclusion

Patient blood management program may reduce inappropriate RBC transfusion. Implementation of PBM was associated with lower risk of CKD progression in hospitalized CKD patients.