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Abstract: TH-PO699

Burden of Anemia in Patients With CKD Stages 3-5 Managed in Primary Care

Session Information

  • Anemia and Iron Metabolism
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism


  • Evans, Marie, Karolinska Institutet, Stockholm, Stockholm, Sweden
  • Xu, Yang, Karolinska Institutet, Stockholm, Stockholm, Sweden
  • Mazhar, Faizan, Karolinska Institutet, Stockholm, Stockholm, Sweden
  • Arnlov, Johan, Karolinska Institutet, Stockholm, Stockholm, Sweden
  • Cockburn, Elinor, Astellas Pharma A/S, Kastrup, Hovedstaden, Denmark
  • Barany, Peter F., Karolinska Universitetssjukhuset, Stockholm, Sweden
  • Carrero, Juan Jesus, Karolinska Institutet, Stockholm, Stockholm, Sweden

General practitioners (GPs) are the first point of contact for patients with chronic kidney disease (CKD), who often remain in the care of their GP until advanced stages of disease. Anemia is a common complication of CKD, but there are limited studies quantifying the burden of CKD-associated anemia in primary care. In this study, we explored anemia incidence, treatment selection, and adverse clinical outcomes in primary care patients with CKD.


We evaluated patients ≥18 years with CKD stages 3–5 managed in primary care in Stockholm, Sweden, from 2012 to 2018, who did not have anemia and had no history of nephrology referral. Incident anemia was defined as persistently low hemoglobin (Hb) values (<12.0 g/dL in women and <13.0 g/dL in men, >3 months apart), anemia international classification of disease diagnosis, or a single low Hb measurement with treatment initiation within 90 days. We evaluated baseline factors associated with anemia incidence and treatment selection, and the association between incident anemia and major adverse cardiovascular events (MACE) or death.


The study included 45,637 adults with CKD stages 3-5 (mean age 78 years, 64% female, 79% CKD stage 3a) managed in primary care; 11,987 (26%) developed anemia during follow-up (median 2.4 years, interquartile range 1.0-4.7). Anemia incidence increased with CKD severity: 78 cases/1000 person-years in CKD stage 3a, to 185 cases/1000 person-years in stages 4-5. The main factors associated with anemia occurrence were older age, male sex, diabetes, and lower estimated glomerular filtration rate. In the six months following incident anemia, treatment was initiated in 2272 (19%) patients, including oral iron (9.9%), blood transfusion (6.6%), and erythropoiesis-stimulating agent (0.2%). Treatment initiation increased with anemia severity. Developing anemia was associated with a higher risk of death (adjusted hazard ratio [HR] 1.33 [95% CI: 1.25–1.42]) and MACE (HR 1.91 [95% CI: 1.77–2.06]).


One in four patients with CKD stages 3–5 developed anemia while managed in primary care. Developing anemia was associated with low treatment rates and poor outcomes, highlighting an opportunity to improve management of CKD-associated complications in primary care.


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