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

Michelle M Y Wong; Charlotte Tu; Yun Li; Rachel L Perlman; Roberto Pecoits-Filho; Antonio A Lopes; Ichiei Narita; Helmut Reichel; Friedrich K Port; Nidhi Sukul; Benedicte Stengel; Bruce M Robinson; Ziad A Massy; Ronald L Pisoni; CKDopps Investigators

doi:10.1093/ckj/sfz091

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

Clin Kidney J. 2019 Aug 3;13(4):613-624. doi: 10.1093/ckj/sfz091. eCollection 2020 Aug.

Authors

Michelle M Y Wong¹, Charlotte Tu², Yun Li³, Rachel L Perlman⁴, Roberto Pecoits-Filho^{1

5}, Antonio A Lopes⁶, Ichiei Narita⁷, Helmut Reichel⁸, Friedrich K Port^{2

9}, Nidhi Sukul⁴, Benedicte Stengel¹⁰, Bruce M Robinson², Ziad A Massy^{10

11}, Ronald L Pisoni²; CKDopps Investigators

Affiliations

¹ Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
² Arbor Research Collaborative for Health, Ann Arbor, MI, USA.
³ School of Public Health, University of Michigan, Ann Arbor, MI, USA.
⁴ Department of Nephrology, University of Michigan, Ann Arbor, MI, USA.
⁵ School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil.
⁶ Faculdade de Medicina da Bahia School of Medicine, Universidade Federal da Bahia, Salvador, Brazil.
⁷ Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan.
⁸ Nephrological Center, Villingen-Schwenningen, Germany.
⁹ Department of Internal Medicine, Michigan Medicine, and Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor MI, USA.
¹⁰ CESP, Center for Research in Epidemiology and Population Health, Univ Paris-Saclay, Univ Paris-Sud, UVSQ, Inserm UMRS 1018, Villejuif, France.
¹¹ Division of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt/Paris, France.

Abstract

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.

Keywords: anemia; chronic kidney disease; erythropoiesis-stimulating agents; iron deficiency; iron supplementation.