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Abstract: TH-PO961

Treatment Patterns and Clinical Events in Non-Dialysis-Dependent CKD Patients with Elevated C-Reactive Protein and Anemia: A Nationwide Hospital-Based Cohort Study in Japan

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism


  • Yoshikawa-Ryan, Kanae, Bayer Yakuhin Kabushiki Kaisha, Osaka, Osaka, Japan
  • Okami, Suguru, Bayer Yakuhin Kabushiki Kaisha, Osaka, Osaka, Japan
  • Tanaka-Mizuno, Sachiko, Kyoto Daigaku, Kyoto, Japan
  • Uenaka, Hidetoshi, Real World Data Co. Ltd., Kyoto, Kyoto, Japan
  • Kimura, Takeshi, Real World Data Co. Ltd., Kyoto, Kyoto, Japan
  • Ishida, Yosuke, Bayer Yakuhin Kabushiki Kaisha, Osaka, Osaka, Japan
  • James, Glen, Bayer AG, Leverkusen, Nordrhein-Westfalen, Germany
  • Hayasaki, Takanori, Bayer Yakuhin Kabushiki Kaisha, Osaka, Osaka, Japan
  • Kuragano, Takahiro, Hyogo Ika Daigaku, Nishinomiya, Hyogo, Japan

Treating anemic CKD patients with inflammation (identified from increased CRP) is challenging due to associated ESA resistance. Contemporary evidence for anemia management and clinical event risk in NDD-CKD patients with elevated CRP are limited.


A retrospective cohort study was conducted using a Japanese nationwide EMR-based hospital database in adult patients with stage≥3a NDD-CKD and Hb<11g/dL (January 2013–November 2021; N=26,626). Serum CRP was collected during the baseline period. Anemia treatment patterns (initiation and discontinuation) and clinical events including all-cause mortality, CV events, dialysis introduction, hospitalization for AKI, and RBC transfusion were assessed.


9086 (34.1%) had normal CRP (<0.3mg/dl, mean 0.1mg/dL), 13,642 (51.2%) had elevated CRP (≥0.3mg/dl, mean 5.4mg/dL), and 3898 (14.6%) had no CRP measurements. Compared to normal CRP, patients with elevated CRP had lower Hb (9.8 vs 10.0g/dL), higher ferritin (212.4 vs 140.9ng/mL), and lower TSAT (23.7 vs 27.5%). The cumulative incidence of anemia treatment initiation within 12 months was lower in patients with elevated CRP (34.1 vs 39.0%), including ESA 23.0%, iron oral 16.5% iron iv 6.0%, and HIF-PHI 0.1%. Anemia treatment discontinuation within 12 months was higher in patients with elevated CRP (88.9 vs 86.9%) including ESA 95.4%, iron oral 81.1%, iron iv 99.3%, and HIF-PHI 60.0%. Incidence rates (per 100 person-years) for all clinical events were higher in patients with elevated CRP. (Fig)


The proportion of patients with elevated CRP was high in anemic NDD-CKD. Combination of anemia and elevated CRP was associated with adverse effects. Despite a significantly higher rate of RBC transfusion, many patients remain untreated and for those treated discontinuation was high in both groups.


  • Commercial Support – Bayer Yakuhin