Anemia and iron deficiency among chronic kidney disease Stages 3–5ND patients in the Chronic Kidney Disease Outcomes and Practice Patterns Study: often unmeasured, variably treated

Wong, Michelle M.Y.; Tu, Charlotte; Li, Yun; Perlman, Rachel L.; Pécoits-Filho, Roberto; Lopes, Antônio Alberto; Narita, Ichiei; Reichel, Helmut; Port, Friedrich K.; Sukul, Nidhi; Stengel, Bénédicte; Robinson, Bruce M.; Massy, Ziad A.; Pisoni, Ronald L.; Combe, Christian; Jacquelinet, Christian; Ayav, Carole; Briançon, Serge; Fouque, Denis; Frimat, Luc; Laville, Maurice; Pascal, Christophe; Herpe, Yves-Edouard; Lange, C.; Legrans, Karine; Liabeuf, Sophie; Metzger, Marie; Speyer, Élodie

doi:10.1093/ckj/sfz091

Cited by 80 publications

(110 citation statements)

References 47 publications

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“…anemia in CKD patients with an eGFR level below 60 ml/min were found to be 38% and 7.5% respectively [12]. In line with previous studies, we observed an association between anemia and decreasing kidney function [2,15].…”

Section: Plos Onesupporting

confidence: 88%

“…Our study is one of the few studies investigating the effects of the medical center on anemia in CKD. Country-specific differences were previously reported [12]. However, to the best of our knowledge, center effect was not investigated for medical centers located in a single country.…”

Section: Plos Onementioning

confidence: 82%

“…According to a recent large-scale multicenter multinational study, there is a striking difference between different countries regarding the frequency of predialysis anemia [12]. However, to the best of our knowledge, center-based differences were not extensively studied previously.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of anemia in predialysis chronic kidney disease: Is the study center a significant factor?

et al. 2020

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Objectives Anemia is highly prevalent in chronic kidney disease patients; however, its identification and management have been reported to be suboptimal. In this study we aimed to describe the prevalence, severity, risk factors, and treatment of anemia in different nephrology centers, among chronic kidney disease patients who were not given renal replacement therapy. Materials and methods We performed a multicenter cross-sectional study in three different nephrology clinics. Adult (>18 years of age) chronic kidney disease patients with an estimated glomerular filtration rate (eGFR) below 60 ml/min, and who were not started dialysis were recruited. Demographic, clinical and laboratory data regarding anemia and its management were collected using a standard data form. Anemia was defined as a hemoglobin level below 12g/dL and severe anemia as a hemoglobin level below 10g/dl. Results A total of 1066 patients were enrolled in the study. Anemia and severe anemia were present in 55.9% and 14.9% of the patients, respectively. The mean hemoglobin level for the whole cohort was 11.8±1.8 g/dL. Univariate analyses revealed that the mean hemoglobin level was significantly different among the centers. Moreover, the frequency of the presence of anemia stratified by severity was also significantly different among the centers. According to binary logistic regression analysis, gender, levels of eGFR and iron, ferritin � 100 ng/mL, and the nephrology center were independent determinants of severe anemia. Conclusions We found a high prevalence of anemia among chronic kidney disease patients who were not on renal replacement therapy. Each center should determine the treatment strategy

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Section: Plos Onesupporting

confidence: 88%

Section: Plos Onementioning

confidence: 82%

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Prevalence of anemia in predialysis chronic kidney disease: Is the study center a significant factor?

et al. 2020

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“…Its prevalence increases with disease progression. [1][2][3][4] Associated symptoms include fatigue and weakness. 5 Persons living with nondialysis (ND)-CKD often have lower health-related quality of life (HRQOL) 2,3,6 and physical functioning 7,8 compared with the general population.…”

Section: Introductionmentioning

confidence: 99%

Associations of Hemoglobin Levels With Health-Related Quality of Life, Physical Activity, and Clinical Outcomes in Persons With Stage 3-5 Nondialysis CKD

Hoshino

Muenz

Zee

et al. 2020

Journal of Renal Nutrition

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, MS, † and on behalf of CKDopps Investigators* Objective: Conflicting findings and knowledge gaps exist regarding links between anemia, physical activity, health-related quality of life (HRQOL), chronic kidney disease (CKD) progression, and mortality in moderate-to-advanced CKD. Using the CKD Outcomes and Practice Patterns Study, we report associations of hemoglobin (Hgb) with HRQOL and physical activity, and associations of Hgb and physical activity with CKD progression and mortality in stage 3-5 nondialysis (ND)-CKD patients. Design and Methods: Prospectively collected data were analyzed from 2,121 ND-CKD stage 3-5 patients, aged $18 years, at 43 nephrologist-run US and Brazil CKD Outcomes and Practice Patterns Study-participating clinics. Cross-sectional associations were assessed of Hgb levels with HRQOL and physical activity levels (from validated Kidney Disease Quality of Life Instrument and Rapid Assessment of Physical Activity surveys). CKD progression (first of $40% estimated glomerular filtration rate [eGFR] decline, eGFR,10 mL/min/1.73 m 2 , or end-stage kidney disease) and all-cause mortality with Hgb and physical activity levels were also evaluated. Linear, logistic, and Cox regression analyses were adjusted for country, demographics, smoking, eGFR, serum albumin, very high proteinuria, and 13 comorbidities. Results: HRQOL was worse, with severe anemia (Hgb,10 g/dL), but also evident for mild/moderate anemia (Hgb 10-12 g/dL), relative to Hgb.12 g/dL. Odds of being highly physically active were substantially greater at Hgb.10.5 g/dL. Lower Hgb was strongly associated with greater CKD progression and mortality, even after extensive adjustment. Physical inactivity was strongly associated with greater mortality and weakly associated with CKD progression. Possible residual confounding is a limitation. Conclusion: This multicenter international study provides real-world observational evidence for greater HRQOL, physical activity, lower CKD progression, and greater survival in ND-CKD patients with Hgb levels .12 g/dL, exceeding current treatment guideline recommendations. These findings help inform future studies aimed at understanding the impact of new anemia therapies and physical activity regimens on improving particular dimensions of ND-CKD patient well-being and clinical outcomes.

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“…Started on haemodialysis (HD), it has expanded to peritoneal dialysis and non-dialysis (ND)-CKD. Recently, anaemia prevalence has been compared in four different countries in ND-CKD [6].…”

Section: Is There Still a Role For Observational Studies?mentioning

confidence: 99%

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

Vecchio¹

2020

J Nephrol

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Anemia and iron deficiency among chronic kidney disease Stages 3–5ND patients in the Chronic Kidney Disease Outcomes and Practice Patterns Study: often unmeasured, variably treated

Cited by 80 publications

References 47 publications

Prevalence of anemia in predialysis chronic kidney disease: Is the study center a significant factor?

Prevalence of anemia in predialysis chronic kidney disease: Is the study center a significant factor?

Associations of Hemoglobin Levels With Health-Related Quality of Life, Physical Activity, and Clinical Outcomes in Persons With Stage 3-5 Nondialysis CKD

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

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