Study Highlights Suboptimal Prescribing of Anemia Medication in Patients With NDD-CKD

Researchers have taken a look at the anemia prescription patterns over time for patients with nondialysis-dependent chronic kidney disease (NDD-CKD), concluding that the condition is suboptimally managed among these patients.

Data from nearly 3000 patients across multiple countries with the disease showed that undertreatment was most notable among patients with hemoglobin (Hb) <10 g/dL. Throughout the approximate 2 years of follow-up, anemia medications were prescribed to less than half (40%) of these patients within 12 months. For erythropoiesis stimulating agents (ESAs) in particular, 28% of these patients were prescribed the medication.

“The results of this longitudinal analysis confirm and extend findings presented in our previous cross-sectional analysis,” commented the researchers. “We found that the majority of NDD-CKD patients who are followed by nephrologists and have low hematinic measures are not given conventional anemia medication within a year.”

Throughout the same 12-month period, 24% of patients with Hb 10 to <12 g/dL received any treatment and 6% of patients with Hb >12 g/dL received treatment. When stratified by CKD stage, 19% of patients with Stage 4 or 5 received treatment compared with 7% of patients with Stage 3.

When treatment was prescribed, it was most often driven by hemoglobin levels and less so by iron stores. The most common prescribed treatment was oral iron therapy, either alone or in combination with an ESA.

“This study also illustrates the underutilization of iron replacement therapies. The preferred route of iron replacement was oral, in this population with a high incidence of [iron deficiency]; from a patient prognosis perspective, this choice of prescription differs with the findings of a randomized clinical trial that reported superiority for IV iron therapy to oral iron in the correction of ID,” wrote the researchers.

According to the researchers, IV iron is usually prescribed at more advanced stages of CKD because of the decrease in iron absorption by the gastrointestinal (GI) tract, as well as a higher rate of GI side effects with oral iron in advanced stages of CKD.

A high prevalence of discontinuation within the first year of treatment also became apparent throughout the study, according to the researchers.

Reference

Lopes M, Tu C, Zee J, et al. A real-world longitudinal study of anemia management in non-dialysis-dependent chronic kidney disease patients: a multinational analysis of CKDopps. Sci Rep. Published online January 19, 2021. doi: 10.1038/s41598-020-79254-6.