Anemia and clinical outcomes in patients with non-dialysis dependent or dialysis dependent severe chronic kidney disease: a Danish population-based study

Abstract

Background Routine clinical evidence is limited on clinical outcomes associated with anemia in patients with severe chronic kidney disease (CKD). Methods We linked population-based medical databases to identify individuals with severe CKD (eGFR < 30 mL/ min/1.73 m 2) in Northern Denmark from 2000 to 2016, including prevalent patients as of 1 January 2009 or incident patients hereafter into the study. We classified patients as non-anemic (≥ 12/≥ 13 g/dl hemoglobin (Hgb) in women/men), anemia grade 1 (10-12/13 g/dl Hgb in women/men), 2 (8-10 g/dl Hgb), and 3+ (< 8 g/dl Hgb), allowing persons to contribute with patient profiles and risk time in consecutively more severe anemia grade cohorts. Patients were stratified by dialysis status and followed for clinical outcomes. Results We identified 16,972 CKD patients contributing with a total of 28,510 anemia patient profiles, of which 3594 had dialysis dependent (DD) and 24,916 had non-dialysis dependent (NDD) severe CKD. Overall, 14% had no anemia, 35% grade 1 anemia, 44% grade 2 anemia and 17% grade 3+ anemia. Compared to patients with no anemia, adjusted hazard ratios (HRs) for NDD patients with grade 3+ anemia were elevated for incident dialysis (1.91, 95% CI 1.61-2.26), any acute hospitalization (1.74, 95% CI 1.57-1.93), all-cause death (1.82, 95% CI 1.70-1.94), and MACE (1.14, 95% CI 1.02-1.26). Similar HRs were observed among DD patients. Conclusions Among NDD or DD patients with severe CKD, presence and severity of anemia were associated with increased risks of incident dialysis for NDD patients and with acute hospitalizations, death and MACE for all patients.

Roxadustat for Treating Anemia in Patients with CKD Not on Dialysis: Results from a Randomized Phase 3 Study

“…Observational studies have shown that patients with anemia of NDD-CKD frequently have a high incidence of adverse clinical outcomes. 9 In OLYMPUS, the safety profile of roxadustat was comparable to placebo, as was seen in previous placebo-controlled roxadustat studies. [37][38][39] More patients receiving roxadustat who had low eGFR or initiated dialysis, which are associated with higher risk of death and cardiovascular events, [6][7][8] remained on roxadustat versus placebo.…”

Anaemia epidemiology in the era of “big data”. Are we aware that the revolution is already going on?

“…The paper by Toft et al [8] is in line with previous findings coming from older cross-sectional studies [9]. Given its longitudinal design, it allows to detect also the incidence of anaemia over time and its burden on outcomes.…”

“…Toft et al [8] presented the findings of a population-based study performed in Northern Denmark on anaemia and clinical outcomes in CKD. Data were obtained linking Danish population-based healthcare and administrative databases.…”

“…Even if Toft et al [8] did not report data on ESA therapy, iron and blood transfusions, more in general administrative database contain information on drug prescription and on their actual consumption through selling reports. This gives unique opportunity to verify prescription strategies in everyday clinical practice and their true impact on patient outcomes.…”

The association of standard Kt/V and surface area‐normalized standard Kt/V with clinical outcomes in hemodialysis patients

“…It has been known that nutritional status, particularly serum albumin, is strongly associated with mortality in HD patients 33,34 . Anemia was also associated with all‐cause mortality in patients with CKD either with or without dialysis dependence 35 . Thus, ensuring adequate dialysis clearance could improve the nutritional status, anemia, and mortality of HD patients.…”