So037anemia Prevalence and Treatment Among Patients With Chronic Kidney Disease Stage 3-5: Data From the Chronic Kidney Disease Outcomes and Practice Patterns Study (Ckdopps)

Wong, Michelle My; Tu, Charlotte; Zepel, Lindsay; Combe, Christian; Lopes, Antônio Alberto; Pécoits-Filho, Roberto; Pisoni, Ronald L.; Port, Friedrich K.; Reichel, Helmut; Robinson, Bruce M.; Massy, Ziad A.

doi:10.1093/ndt/gfw123.05

Cited by 6 publications

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“…ESA and iron use in patients with Hgb < 11 g/dL were more common in Brazil and Germany, and the mean Hb at ESA start was higher in Brazil (10.9 g/dL) and Germany (10.2) than in the US (9.6), possibly due to differences in regional guidelines, as well as different norms for medication access in those countries 40 , 41 , as well as physician-led decisions and practice preferences. A previous analysis from the CKDopps nephrologist practice survey indicates that the most common hemoglobin threshold for starting ESA therapy significantly varies across countries, particularly in countries with a more emphatic restriction of ESA therapy 42 . To the best of our knowledge, this is the first analysis that explores real-world country differences in longitudinal anemia management in NDD-CKD patients.…”

Section: Discussionmentioning

confidence: 99%

A real-world longitudinal study of anemia management in non-dialysis-dependent chronic kidney disease patients: a multinational analysis of CKDopps

Lopes

Zee

et al. 2021

Sci Rep

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Previously lacking in the literature, we describe longitudinal patterns of anemia prescriptions for non-dialysis-dependent chronic kidney disease (NDD-CKD) patients under nephrologist care. We analyzed data from 2818 Stage 3-5 NDD-CKD patients from Brazil, Germany, and the US, naïve to anemia medications (oral iron, intravenous [IV] iron, or erythropoiesis stimulating agent [ESA]) at enrollment in the CKDopps. We report the cumulative incidence function (CIF) of medication initiation stratified by baseline characteristics. Even in patients with hemoglobin (Hb) < 10 g/dL, the CIF at 12 months for any anemia medication was 40%, and 28% for ESAs. Patients with TSAT < 20% had a CIF of 26% and 6% for oral and IV iron, respectively. Heart failure was associated with earlier initiation of anemia medications. IV iron was prescribed to < 10% of patients with iron deficiency. Only 40% of patients with Hb < 10 g/dL received any anemia medication within a year. Discontinuation of anemia treatment was very common. Anemia treatment is initiated in a limited number of NDD-CKD patients, even in those with guideline-based indications to treat. Hemoglobin trajectory and a history of heart failure appear to guide treatment start. These results support the concept that anemia is sub-optimally managed among NDD-CKD patients in the real-world setting.

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Section: Discussionmentioning

confidence: 99%

A real-world longitudinal study of anemia management in non-dialysis-dependent chronic kidney disease patients: a multinational analysis of CKDopps

Lopes

Zee

et al. 2021

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“…ERBP offers a similar stance, suggesting ESA initiation at hemoglobin values between 9 and 10 g/dL, with consideration of initiation at higher hemoglobin levels in patients with worsening ischemic symptoms associated with anemia [ 25 ]. Preliminary data from the CKDopps nephrologist practice survey indicate that the most common hemoglobin threshold for prescribing ESA is ≤9 g/dL in the USA, ≤9.5 g/dL in France and ≤10 g/dL in Brazil [ 42 ]. The lower hemoglobin threshold for ESA initiation favored among US nephrologists may explain the relatively lower ESA prescription rate in the USA compared with other CKDopps countries.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

Clinical Kidney Journal

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Background International variation in anemia assessment and management practices in chronic kidney disease (CKD) is poorly understood. Methods We performed a cross-sectional analysis of anemia laboratory monitoring, prevalence and management in the prospective Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps). A total of 6766 participants with CKD Stages 3a–5ND from nephrology clinics in Brazil, France, Germany and the USA were included. Results Among patients with anemia (hemoglobin <12 g/dL), 36–58% in Brazil, the USA and Germany had repeat hemoglobin measured and 40–61% had iron indices measured within 3 months of the index hemoglobin measurement. Anemia was more common in the USA and Brazil than in France and Germany across CKD stages. Higher ferritin and lower iron saturation (TSAT) levels were observed with lower hemoglobin levels, and higher ferritin with more advanced CKD. The proportion of anemic patients with ferritin <100 ng/mL or TSAT <20% ranged from 42% in Brazil to 53% in France and Germany, and of these patients, over 40% in Brazil, Germany and the USA, compared with 27% in France, were treated with oral or intravenous iron within 3 months after hemoglobin measurement. The proportion of patients with hemoglobin <10 g/dL treated with erythropoiesis-stimulating agents ranged from 28% in the USA to 57% in Germany. Conclusions Hemoglobin and iron stores are measured less frequently than per guidelines. Among all regions, there was a substantial proportion of anemic patients with iron deficiency who were not treated with iron, highlighting an area for practice improvement in CKD care.

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“…Ferric citrate coordination complex was rarely discontinued due to intolerability and adverse events were essentially limited to the GI organ system, as has been previously reported. 11 Globally, nearly 70% of patients with eGFR,20 ml/min per 1.73 m 2 are anemic, largely the result of relative 12 The optimal management of anemia in patients with CKD is unclear and the role of oral versus intravenous iron remains controversial. The FIND-CKD investigators randomized 626 patients with non-dialysis-dependent CKD (eGFR,60 ml/min per 1.73 m 2 ) and presumed iron deficiency (TSAT,20%, ferritin,100 ng/ml) to two different intravenous iron strategies (high or low ferritin) versus oral iron (ferrous sulfate 100 mg twice daily) and showed that the low-dose intravenous iron and oral iron strategies were equivalent in raising hemoglobin (mean increase 0.9-1.0 g/dl).…”

Section: Discussionmentioning

confidence: 99%

A Pilot Randomized Trial of Ferric Citrate Coordination Complex for the Treatment of Advanced CKD

Block

Smits

et al. 2019

JASN

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BackgroundResearchers have yet to determine the optimal care of patients with advanced CKD. Evidence suggests that anemia and CKD-related disordered mineral metabolism (including abnormalities in phosphate and fibroblast growth factor 23 [FGF23]) contribute to adverse outcomes in this population.Methods To investigate whether fixed-dose ferric citrate coordination complex favorably affects multiple biochemical parameters in patients with advanced CKD, we randomly assigned 203 patients with eGFR#20 ml/min per 1.73 m 2 2:1 to receive a fixed dose of ferric citrate coordination complex (two tablets per meal, 210 mg ferric iron per tablet) or usual care for 9 months or until 3 months after starting dialysis. No single biochemical end point was designated as primary; sample size was determined empirically. ResultsThe two groups had generally similar baseline characteristics, although diabetes and peripheral vascular disease were more common in the usual-care group. Ferric citrate coordination complex significantly increased hemoglobin, transferrin saturation, and serum ferritin, and it significantly reduced serum phosphate and intact FGF23 (P,0.001 for all). Of the 133 patients randomized to ferric citrate coordination complex, 31 (23%) initiated dialysis during the study period, as did 32 of 66 (48%) patients randomized to usual care (P=0.001). Compared with usual care, ferric citrate coordination complex treatment resulted in significantly fewer annualized hospital admissions, fewer days in hospital, and a lower incidence of the composite end point of death, provision of dialysis, or transplantation (P=0.002). ConclusionsThe beneficial effects of fixed-dose ferric citrate coordination complex on biochemical parameters, as well as the exploratory results regarding the composite end point and hospitalization, suggest that fixed-dose ferric citrate coordination complex has an excellent safety profile in an unselected population with advanced CKD and merits further study.

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So037anemia Prevalence and Treatment Among Patients With Chronic Kidney Disease Stage 3-5: Data From the Chronic Kidney Disease Outcomes and Practice Patterns Study (Ckdopps)

Cited by 6 publications

References 0 publications

A real-world longitudinal study of anemia management in non-dialysis-dependent chronic kidney disease patients: a multinational analysis of CKDopps

A real-world longitudinal study of anemia management in non-dialysis-dependent chronic kidney disease patients: a multinational analysis of CKDopps

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

A Pilot Randomized Trial of Ferric Citrate Coordination Complex for the Treatment of Advanced CKD

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