DISCOVER CKD: Variations in Treatment for CKD-Related Anemia

NKF Spring Clinical Meetings 2021

Anemia in chronic kidney disease (CKD) commonly remains untreated until patients require dialysis. During a virtual poster session at the NKF Spring Clinical Meetings 2021, Eric Wittbrodt, MPH, PharmD, and colleagues described characteristics of patients with and without dialysis dependent CKD and anemia receiving a transfusion or intravenous (IV) iron in the DISCOVER CKD retrospective cohort. The poster was titled Characteristics of Patients with and without Dialysis Dependent Chronic Kidney Disease and Anemia Receiving Blood Transfusions and Intravenous Iron: A Report from the DISCOVER CKD Retrospective Cohort.

Data for adult patients (≥18 years of age) with CKD and anemia were obtained from the UK CPRD (United Kingdom Clinical Practice Research Datalink), Japan JMDC (Japan Medical Data Center), and US LCED (United States Limited Claims and Electronic Health Record) databases. The index date was defined as the first hemoglobin level of <12 g/dL for females and <13 g/dL for males or a prescription for anemia therapy (iron, erythropoiesis-stimulating agent, or transfusion) on or after a diagnosis code for CKD stage 3a+ or dialysis or the second of two estimated glomerular filtration rate measurements of <60 mL/min/1.73 m2 >90 days apart between January 2008 and March 2020.

During follow-up, 27% of 72,429 patients were treated with anemia therapies, 25% of which were transfusion or IV iron. Median times from index date to initiation of blood transfusion were 285 days (US), 232 days (Japan) and 306 days (UK); for IV iron, the median times were 238 days (US), 291 days (Japan) and 929 days (UK).

Patients in the US and Japan cohorts had a higher proportion of comorbidities compared with patients in the UK cohort. Among patients receiving a transfusion, median hemoglobin ranged from 7.9 to 8.9 g/dL; among those receiving IV iron, hemoglobin range was 8.9 to 10.5 g/dL.

The researchers said, “There were clear country differences observed in the routine clinical care of anemia in patients with CKD. Transfusion and IV iron were commonly used as rescue therapies despite their invasive nature and well-recognized associations between transfusion and adverse reactions such as allosensitization and infection.”

Source: Wittbrodt E, Carrero JJ, James G, et al. Characteristics of patients with and without dialysis dependent chronic kidney disease and anemia receiving blood transfusion and intravenous iron: A report from the DISCOVER CKD retrospective cohort. Abstract of a poster presented during the National Kidney Foundation virtual Spring Clinical Meetings 2021 (Abstract #181), April 9, 2021.