Patients in the care of nephrologists are commonly prescribed erythropoiesis-stimulating agents (ESAs) and iron supplements. However, according to Naoki Okamoto, MD, and colleagues, there are few data detailing the differences in prescription rates of ESAs and iron supplements among non-nephrology clinical departments.
The researchers conducted a study to examine prescription practices of ESAs and iron supplements among clinical departments, including nephrology. Results were reported online in Clinical and Experimental Nephrology [doi:10.1007/s10157-022-02194-0].
A total of 39,585 patients with estimated glomerular filtration rate of <60 mL/min/1.73 m2 were identified from a database of 914,280 patients. The patients were treated in any of eight clinical departments from internal medicine (including nephrology). Anemia was defined as hemoglobin level less than 11.0 g/dL and cutoff points of 20% of transferrin saturation and 100 ng/mL of serum ferritin were used. The researchers compared prescription rates of ESAs and iron supplementation based on hemoglobin level and iron status among the patients seen in the eight clinical departments.
Patients with lower eGFR were more likely to seen under nephrology care. The rates of patients with no prescription for either an ESA or iron supplement were 52.3%, 39.9%, 45.9%, and 54.3% among patients with hemoglobin levels <8, 8 to <9, 9 to <10, and ≥10 to <11 g/dL, respectively.
Among patients with less than 11 g/dL of hemoglobin, 77.3% were prescribed ESAs under nephrology care. Among patients treated in clinical departments of internal medicine other than nephrology, only 18.5% of patients were prescribed an ESA. Among patients treated in clinical departments in non-internal medicine, only 8.2% were prescribed and ESA.
In conclusion, the authors said, “Treatment for anemia has not been sufficiently performed in patients with renal impairment under non-nephrology care in a real-world clinical setting.”