Anemia Is Underrecognized, Undertreated in CKD

Anemia is underrecognized in patients with chronic kidney disease (CKD), despite guidelines, according to the results of a recent study.

For their study, the researchers sought to examine variation in trends of anemia assessment and management internationally. “In addition to practice variation between countries, we hypothesized there would also be substantial variation at the clinic level based on local practice patterns, individualization of treatment and nephrologist preferences,” they wrote.

They conducted a cross-sectional analysis of data from the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps) including 6766 patients with eGFR <60 mL/min/1.73 m2 with CKD stages 3a-5ND from Brazil, France, Germany, and the US. Participants were excluded if they had not completed baseline demographics/medical history questionnaires or had no hemoglobin measurements 6 months prior to enrollment or within 6 months after enrollment.

Overall, anemia was more common in Brazil and in the US than it was in France and Germany. Of the participants with anemia, 36%-58% in Brazil, the US, and Germany had repeat measurements of hemoglobin and 40%-61% had iron indices measured within 3 months of the indexing hemoglobin measurement.

Of the patients with anemia who had ferritin levels <100 ng/mL or iron saturation TSAT <20%, more than 40% in the US, Brazil, and Germany were treated with oral or intravenous iron within 3 months of hemoglobin measurement, compared with 27% in France.

“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,” the researchers concluded.

—Michael Potts

Reference:

Wong MMY, Tu C, Li Y, et al. 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. CKJ. 2020;13(4):613-624.