Real-Life Anemia Management Among Patients with Non-Dialysis-Dependent Chronic Kidney Disease in Three European Countries

Danilo Fliser; Maria Mata Lorenzo; Katherine Houghton; Claire Ainsworth; Martin Blogg; Elena González de Antona Sánchez; Jose Portoles

doi:10.2147/IJNRD.S401598

Real-Life Anemia Management Among Patients with Non-Dialysis-Dependent Chronic Kidney Disease in Three European Countries

Int J Nephrol Renovasc Dis. 2023 Apr 13:16:115-129. doi: 10.2147/IJNRD.S401598. eCollection 2023.

Authors

Danilo Fliser¹, Maria Mata Lorenzo², Katherine Houghton³, Claire Ainsworth³, Martin Blogg², Elena González de Antona Sánchez⁴, Jose Portoles⁵

Affiliations

¹ Saarland University Medical Center, Homburg, Germany.
² Astellas Pharma Europe Ltd., Addlestone, UK.
³ RTI Health Solutions, Manchester, UK.
⁴ Astellas Pharma España S.A., Madrid, Spain.
⁵ Hospital Universitario Puerta de Hierro, Madrid, Spain.

Abstract

Background: Anemia is prevalent among patients with chronic kidney disease (CKD), yet current evidence indicates that treatment may not adhere to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. We aimed to document the management of patients with non-dialysis-dependent (NDD)-CKD receiving erythropoiesis-stimulating agent (ESA) therapy in Europe.

Methods: This retrospective, observational study extracted information from medical records in Germany, Spain, and the UK. Eligible patients were adults with NDD-CKD stages 3b-5 who initiated ESA therapy for anemia between January and December 2015. Anemia was defined as hemoglobin (Hb) <13.0 g/dL (males) or <12.0 g/dL (females). Data regarding ESA treatment, treatment response, concomitant iron therapy and blood transfusions were extracted up to 24 months post-ESA initiation, and data on CKD progression until abstraction date.

Results: Eight hundred and forty-eight medical records were abstracted. Approximately 40% received no iron therapy prior to ESA initiation. At ESA initiation, mean ± standard deviation Hb level was 9.8 ± 1.0 g/dL. Most patients received darbepoetin alfa, and switching between ESAs was rare (8.5% of patients). Concomitant intravenous and oral iron therapy was prescribed for 36% and 42% of patients, respectively, during initial ESA therapy. Mean Hb levels reached the target level (10-12 g/dL) within 3-6 months of ESA initiation. Hb, transferrin saturation, and ferritin levels were infrequently monitored from 3 months post-ESA initiation. Rates of blood transfusion, dialysis, and diagnosis of end-stage renal disease were 16.4%, 19.3%, and 24.6%, respectively. Rates of kidney transplant and death were 4.8% and 8.8%, respectively.

Conclusion: Among ESA-treated patients, ESA initiation was in accordance with KDIGO guidelines, but subsequent monitoring of Hb and iron deficiency were suboptimal.

Keywords: anemia; chronic kidney disease; clinical care process; erythropoiesis-stimulating agents; iron therapy; real-life management.

Grants and funding

This study was initiated and supported by Astellas Pharma, Inc. Medical writing support was provided by Iona Easthope, DPhil, of Lumanity, funded by Astellas Pharma Inc.