Mortality in Patients with Anemia of CKD

Among patients with chronic kidney disease (CKD), the most common causes of death are cardiovascular etiologies, including diabetes mellitus. Ajay K. Singh, MBBS, FRCP, MBA, and colleagues conducted a post-hoc analysis of adjudicated causes of death in patients with anemia both with and without diabetes mellitus in the ASCEND-ND trial. The analysis was designed to examine the safety of daprodustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor, for the treatment of anemia of CKD in patients not on dialysis.

Results of the analysis were reported during a poster session at the American Society of Nephrology Kidney Week 2022. The poster was titled Causes of Death in Patients With Anemia of CKD (With/Without Diabetes Mellitus) in the ASCEND-ND trial.

The ASCEND-ND trial (NCT02876835) was a global, randomized, open-label, phase 3 cardiovascualr outcome trial. Trial participants received daily oral daprodustat or subcutaneous darbepoetin alfa. Trial outcomes were centrally adjudicated. Kaplan-Meier methods were used to analyze survival data for the intent-to-treat population (diabetes mellitus vs non-diabetes mellitus).

A total of 3872 patients were randomized (diabetes mellitus n=2194; non-diabetes mellitus n=1678). The two treatment arms were generally balanced in baseline characteristics. Patients with diabetes were older, had greater body mass index, higher systolic blood pressure, and more cardiovascular disease and use of cardiovascular medication compared with the patients without diabetes.

All-cause mortality was significantly higher among patients with diabetes compared with those without diabetes (hazard ratio [HR], 1.87; 95% CI, 1.57-2.23). The association did not differ by treatment (HR, 1.87 [daprodustat] vs 1.86 [darbepoetin alfa]; P=.96). Independent of diabetes mellitus status, infection and cardiovascualr mortality accounted for approximately 30% of deaths.

“In patients with anemia of CKD not on dialysis, the overall death rate was higher in diabetes mellitus patients, but cause of death was similar regardless of diabetes mellitus status; infection in patients with or without diabetes mellitus was the most frequent cause of death,” the researchers said.

Source: Singh AK, Aarup M. Claggett B, et al. Causes of death in patents with anemia of CKD (with/without diabetes mellitus) in the ASCEND-ND trial. TH-PO685. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2022; November 3, 2022; Orlando, Florida.