Real-Life Anemia Management Among Patients with Non-Dialysis-Dependent Chronic Kidney Disease in Three European Countries
Danilo Fliser,1 Maria Mata Lorenzo,2 Katherine Houghton,3 Claire Ainsworth,3 Martin Blogg,2 Elena González de Antona Sánchez,4 Jose Portoles5 1Saarland University Medical Center, Homburg, Germany; 2Astellas Pharma Europe Ltd., Addlestone, UK; 3RTI Health Solutions, Manchester, UK; 4Astellas Pharma E...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2023-04-01
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| Series: | International Journal of Nephrology and Renovascular Disease |
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| Online Access: | https://www.dovepress.com/real-life-anemia-management-among-patients-with-non-dialysis-dependent-peer-reviewed-fulltext-article-IJNRD |
| _version_ | 1797847445532573696 |
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| author | Fliser D Mata Lorenzo M Houghton K Ainsworth C Blogg M González de Antona Sánchez E Portoles J |
| author_facet | Fliser D Mata Lorenzo M Houghton K Ainsworth C Blogg M González de Antona Sánchez E Portoles J |
| author_sort | Fliser D |
| collection | DOAJ |
| description | Danilo Fliser,1 Maria Mata Lorenzo,2 Katherine Houghton,3 Claire Ainsworth,3 Martin Blogg,2 Elena González de Antona Sánchez,4 Jose Portoles5 1Saarland University Medical Center, Homburg, Germany; 2Astellas Pharma Europe Ltd., Addlestone, UK; 3RTI Health Solutions, Manchester, UK; 4Astellas Pharma España S.A., Madrid, Spain; 5Hospital Universitario Puerta de Hierro, Madrid, SpainCorrespondence: Danilo Fliser, Saarland University Medical Center, Homburg, Germany, Tel +49 – 6841 – 16 15040, Fax +49 – 6841 – 16 15454, Email danilo.fliser@uks.euBackground: 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.Graphical Abstract: Keywords: anemia, chronic kidney disease, clinical care process, erythropoiesis-stimulating agents, iron therapy, real-life management |
| first_indexed | 2024-04-09T18:11:26Z |
| format | Article |
| id | doaj.art-8e1948fd45b54e12ac5251e9360431d0 |
| institution | Directory Open Access Journal |
| issn | 1178-7058 |
| language | English |
| last_indexed | 2024-04-09T18:11:26Z |
| publishDate | 2023-04-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Journal of Nephrology and Renovascular Disease |
| spelling | doaj.art-8e1948fd45b54e12ac5251e9360431d02023-04-13T19:17:09ZengDove Medical PressInternational Journal of Nephrology and Renovascular Disease1178-70582023-04-01Volume 1611512983011Real-Life Anemia Management Among Patients with Non-Dialysis-Dependent Chronic Kidney Disease in Three European CountriesFliser DMata Lorenzo MHoughton KAinsworth CBlogg MGonzález de Antona Sánchez EPortoles JDanilo Fliser,1 Maria Mata Lorenzo,2 Katherine Houghton,3 Claire Ainsworth,3 Martin Blogg,2 Elena González de Antona Sánchez,4 Jose Portoles5 1Saarland University Medical Center, Homburg, Germany; 2Astellas Pharma Europe Ltd., Addlestone, UK; 3RTI Health Solutions, Manchester, UK; 4Astellas Pharma España S.A., Madrid, Spain; 5Hospital Universitario Puerta de Hierro, Madrid, SpainCorrespondence: Danilo Fliser, Saarland University Medical Center, Homburg, Germany, Tel +49 – 6841 – 16 15040, Fax +49 – 6841 – 16 15454, Email danilo.fliser@uks.euBackground: 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.Graphical Abstract: Keywords: anemia, chronic kidney disease, clinical care process, erythropoiesis-stimulating agents, iron therapy, real-life managementhttps://www.dovepress.com/real-life-anemia-management-among-patients-with-non-dialysis-dependent-peer-reviewed-fulltext-article-IJNRDanemiachronic kidney diseaseclinical care processerythropoiesis-stimulating agentsiron therapyreal-life management |
| spellingShingle | Fliser D Mata Lorenzo M Houghton K Ainsworth C Blogg M González de Antona Sánchez E Portoles J Real-Life Anemia Management Among Patients with Non-Dialysis-Dependent Chronic Kidney Disease in Three European Countries International Journal of Nephrology and Renovascular Disease anemia chronic kidney disease clinical care process erythropoiesis-stimulating agents iron therapy real-life management |
| title | Real-Life Anemia Management Among Patients with Non-Dialysis-Dependent Chronic Kidney Disease in Three European Countries |
| title_full | Real-Life Anemia Management Among Patients with Non-Dialysis-Dependent Chronic Kidney Disease in Three European Countries |
| title_fullStr | Real-Life Anemia Management Among Patients with Non-Dialysis-Dependent Chronic Kidney Disease in Three European Countries |
| title_full_unstemmed | Real-Life Anemia Management Among Patients with Non-Dialysis-Dependent Chronic Kidney Disease in Three European Countries |
| title_short | Real-Life Anemia Management Among Patients with Non-Dialysis-Dependent Chronic Kidney Disease in Three European Countries |
| title_sort | real life anemia management among patients with non dialysis dependent chronic kidney disease in three european countries |
| topic | anemia chronic kidney disease clinical care process erythropoiesis-stimulating agents iron therapy real-life management |
| url | https://www.dovepress.com/real-life-anemia-management-among-patients-with-non-dialysis-dependent-peer-reviewed-fulltext-article-IJNRD |
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