Anemia and iron deficiency among chronic kidney disease Stages 3–5ND patients in the Chronic Kidney Disease Outcomes and Practice Patterns Study: often unmeasured, variably treated
BackgroundInternational variation in anemia assessment and management practices in chronic kidney disease (CKD) is poorly understood.Methods We performed a cross-sectional analysis of anemia laboratory monitoring, prevalence and management in the prospective Chronic Kidney Disease Outcomes and Pract...
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| Published in: | Clinical Kidney Journal Vol. 13; no. 4; pp. 613 - 624 |
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| Main Authors: | , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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Oxford University Press
01.08.2020
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| ISSN: | 2048-8513, 2048-8505, 2048-8513 |
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| Abstract | BackgroundInternational variation in anemia assessment and management practices in chronic kidney disease (CKD) is poorly understood.Methods We performed a cross-sectional analysis of anemia laboratory monitoring, prevalence and management in the prospective Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps). A total of 6766 participants with CKD Stages 3a–5ND from nephrology clinics in Brazil, France, Germany and the USA were included.ResultsAmong patients with anemia (hemoglobin <12 g/dL), 36–58% in Brazil, the USA and Germany had repeat hemoglobin measured and 40–61% had iron indices measured within 3 months of the index hemoglobin measurement. Anemia was more common in the USA and Brazil than in France and Germany across CKD stages. Higher ferritin and lower iron saturation (TSAT) levels were observed with lower hemoglobin levels, and higher ferritin with more advanced CKD. The proportion of anemic patients with ferritin <100 ng/mL or TSAT <20% ranged from 42% in Brazil to 53% in France and Germany, and of these patients, over 40% in Brazil, Germany and the USA, compared with 27% in France, were treated with oral or intravenous iron within 3 months after hemoglobin measurement. The proportion of patients with hemoglobin <10 g/dL treated with erythropoiesis-stimulating agents ranged from 28% in the USA to 57% in Germany.ConclusionsHemoglobin and iron stores are measured less frequently than per guidelines. Among all regions, there was a substantial proportion of anemic patients with iron deficiency who were not treated with iron, highlighting an area for practice improvement in CKD care. |
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| AbstractList | Background. International variation in anemia assessment and management practices in chronic kidney disease (CKD) is poorly understood. Methods. We performed a cross-sectional analysis of anemia laboratory monitoring, prevalence and management in the prospective Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps). A total of 6766 participants with CKD Stages 3a-5ND from nephrology clinics in Brazil, France, Germany and the USA were included. Results. Among patients with anemia (hemoglobin <12g/dL), 36-58% in Brazil, the USA and Germany had repeat hemoglobin measured and 40-61% had iron indices measured within 3months of the index hemoglobin measurement. Anemia was more common in the USA and Brazil than in France and Germany across CKD stages. Higher ferritin and lower iron saturation (TSAT) levels were observed with lower hemoglobin levels, and higher ferritin with more advanced CKD. The proportion of anemic patients with ferritin <100 ng/mL or TSAT <20% ranged from 42% in Brazil to 53% in France and Germany, and of these patients, over 40% in Brazil, Germany and the USA, compared with 27% in France, were treated with oral or intravenous iron within 3months after hemoglobin measurement. The proportion of patients with hemoglobin <10 g/dL treated with erythropoiesis-stimulating agents ranged from 28% in the USA to 57% in Germany. Conclusions. Hemoglobin and iron stores are measured less frequently than per guidelines. Among all regions, there was a substantial proportion of anemic patients with iron deficiency who were not treated with iron, highlighting an area for practice improvement in CKD care. Keywords: anemia, chronic kidney disease, erythropoiesis-stimulating agents, iron deficiency, iron supplementation BackgroundInternational variation in anemia assessment and management practices in chronic kidney disease (CKD) is poorly understood.Methods We performed a cross-sectional analysis of anemia laboratory monitoring, prevalence and management in the prospective Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps). A total of 6766 participants with CKD Stages 3a–5ND from nephrology clinics in Brazil, France, Germany and the USA were included.ResultsAmong patients with anemia (hemoglobin <12 g/dL), 36–58% in Brazil, the USA and Germany had repeat hemoglobin measured and 40–61% had iron indices measured within 3 months of the index hemoglobin measurement. Anemia was more common in the USA and Brazil than in France and Germany across CKD stages. Higher ferritin and lower iron saturation (TSAT) levels were observed with lower hemoglobin levels, and higher ferritin with more advanced CKD. The proportion of anemic patients with ferritin <100 ng/mL or TSAT <20% ranged from 42% in Brazil to 53% in France and Germany, and of these patients, over 40% in Brazil, Germany and the USA, compared with 27% in France, were treated with oral or intravenous iron within 3 months after hemoglobin measurement. The proportion of patients with hemoglobin <10 g/dL treated with erythropoiesis-stimulating agents ranged from 28% in the USA to 57% in Germany.ConclusionsHemoglobin and iron stores are measured less frequently than per guidelines. Among all regions, there was a substantial proportion of anemic patients with iron deficiency who were not treated with iron, highlighting an area for practice improvement in CKD care. International variation in anemia assessment and management practices in chronic kidney disease (CKD) is poorly understood.BACKGROUNDInternational variation in anemia assessment and management practices in chronic kidney disease (CKD) is poorly understood.We performed a cross-sectional analysis of anemia laboratory monitoring, prevalence and management in the prospective Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps). A total of 6766 participants with CKD Stages 3a-5ND from nephrology clinics in Brazil, France, Germany and the USA were included.METHODSWe performed a cross-sectional analysis of anemia laboratory monitoring, prevalence and management in the prospective Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps). A total of 6766 participants with CKD Stages 3a-5ND from nephrology clinics in Brazil, France, Germany and the USA were included.Among patients with anemia (hemoglobin <12 g/dL), 36-58% in Brazil, the USA and Germany had repeat hemoglobin measured and 40-61% had iron indices measured within 3 months of the index hemoglobin measurement. Anemia was more common in the USA and Brazil than in France and Germany across CKD stages. Higher ferritin and lower iron saturation (TSAT) levels were observed with lower hemoglobin levels, and higher ferritin with more advanced CKD. The proportion of anemic patients with ferritin <100 ng/mL or TSAT <20% ranged from 42% in Brazil to 53% in France and Germany, and of these patients, over 40% in Brazil, Germany and the USA, compared with 27% in France, were treated with oral or intravenous iron within 3 months after hemoglobin measurement. The proportion of patients with hemoglobin <10 g/dL treated with erythropoiesis-stimulating agents ranged from 28% in the USA to 57% in Germany.RESULTSAmong patients with anemia (hemoglobin <12 g/dL), 36-58% in Brazil, the USA and Germany had repeat hemoglobin measured and 40-61% had iron indices measured within 3 months of the index hemoglobin measurement. Anemia was more common in the USA and Brazil than in France and Germany across CKD stages. Higher ferritin and lower iron saturation (TSAT) levels were observed with lower hemoglobin levels, and higher ferritin with more advanced CKD. The proportion of anemic patients with ferritin <100 ng/mL or TSAT <20% ranged from 42% in Brazil to 53% in France and Germany, and of these patients, over 40% in Brazil, Germany and the USA, compared with 27% in France, were treated with oral or intravenous iron within 3 months after hemoglobin measurement. The proportion of patients with hemoglobin <10 g/dL treated with erythropoiesis-stimulating agents ranged from 28% in the USA to 57% in Germany.Hemoglobin and iron stores are measured less frequently than per guidelines. Among all regions, there was a substantial proportion of anemic patients with iron deficiency who were not treated with iron, highlighting an area for practice improvement in CKD care.CONCLUSIONSHemoglobin and iron stores are measured less frequently than per guidelines. Among all regions, there was a substantial proportion of anemic patients with iron deficiency who were not treated with iron, highlighting an area for practice improvement in CKD care. International variation in anemia assessment and management practices in chronic kidney disease (CKD) is poorly understood. We performed a cross-sectional analysis of anemia laboratory monitoring, prevalence and management in the prospective Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps). A total of 6766 participants with CKD Stages 3a-5ND from nephrology clinics in Brazil, France, Germany and the USA were included. Among patients with anemia (hemoglobin <12 g/dL), 36-58% in Brazil, the USA and Germany had repeat hemoglobin measured and 40-61% had iron indices measured within 3 months of the index hemoglobin measurement. Anemia was more common in the USA and Brazil than in France and Germany across CKD stages. Higher ferritin and lower iron saturation (TSAT) levels were observed with lower hemoglobin levels, and higher ferritin with more advanced CKD. The proportion of anemic patients with ferritin <100 ng/mL or TSAT <20% ranged from 42% in Brazil to 53% in France and Germany, and of these patients, over 40% in Brazil, Germany and the USA, compared with 27% in France, were treated with oral or intravenous iron within 3 months after hemoglobin measurement. The proportion of patients with hemoglobin <10 g/dL treated with erythropoiesis-stimulating agents ranged from 28% in the USA to 57% in Germany. Hemoglobin and iron stores are measured less frequently than per guidelines. Among all regions, there was a substantial proportion of anemic patients with iron deficiency who were not treated with iron, highlighting an area for practice improvement in CKD care. |
| Audience | Academic |
| Author | Narita, Ichiei Li, Yun Massy, Ziad A Robinson, Bruce M Reichel, Helmut Sukul, Nidhi Lopes, Antonio A Wong, Michelle M Y Tu, Charlotte Perlman, Rachel L Pecoits-Filho, Roberto Stengel, Benedicte Port, Friedrich K Pisoni, Ronald L |
| AuthorAffiliation | 4 Department of Nephrology, University of Michigan , Ann Arbor, MI, USA 3 School of Public Health, University of Michigan , Ann Arbor, MI, USA 10 CESP, Center for Research in Epidemiology and Population Health, Univ Paris-Saclay, Univ Paris-Sud , UVSQ, Inserm UMRS 1018, Villejuif, France 8 Nephrological Center, Villingen-Schwenningen , Germany 6 Faculdade de Medicina da Bahia School of Medicine, Universidade Federal da Bahia , Salvador, Brazil 1 Department of Medicine, University of British Columbia , Vancouver, BC, Canada 2 Arbor Research Collaborative for Health , Ann Arbor, MI, USA 11 Division of Nephrology, Ambroise Paré University Hospital , APHP, Boulogne-Billancourt/Paris, France 5 School of Medicine, Pontificia Universidade Catolica do Parana , Curitiba, PR, Brazil 7 Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Science , Niigata, Japan 9 Department of Internal Medicine, Michigan Medicine, and Department of Epidemiology, School |
| AuthorAffiliation_xml | – name: 9 Department of Internal Medicine, Michigan Medicine, and Department of Epidemiology, School of Public Health, University of Michigan , Ann Arbor MI, USA – name: 4 Department of Nephrology, University of Michigan , Ann Arbor, MI, USA – name: 5 School of Medicine, Pontificia Universidade Catolica do Parana , Curitiba, PR, Brazil – name: 1 Department of Medicine, University of British Columbia , Vancouver, BC, Canada – name: 6 Faculdade de Medicina da Bahia School of Medicine, Universidade Federal da Bahia , Salvador, Brazil – name: 7 Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Science , Niigata, Japan – name: 2 Arbor Research Collaborative for Health , Ann Arbor, MI, USA – name: 10 CESP, Center for Research in Epidemiology and Population Health, Univ Paris-Saclay, Univ Paris-Sud , UVSQ, Inserm UMRS 1018, Villejuif, France – name: 11 Division of Nephrology, Ambroise Paré University Hospital , APHP, Boulogne-Billancourt/Paris, France – name: 3 School of Public Health, University of Michigan , Ann Arbor, MI, USA – name: 8 Nephrological Center, Villingen-Schwenningen , Germany |
| Author_xml | – sequence: 1 givenname: Michelle M Y surname: Wong fullname: Wong, Michelle M Y email: mimywong@mail.ubc.ca organization: Department of Medicine, University of British Columbia, Vancouver, BC, Canada – sequence: 2 givenname: Charlotte surname: Tu fullname: Tu, Charlotte organization: Arbor Research Collaborative for Health, Ann Arbor, MI, USA – sequence: 3 givenname: Yun surname: Li fullname: Li, Yun organization: School of Public Health, University of Michigan, Ann Arbor, MI, USA – sequence: 4 givenname: Rachel L surname: Perlman fullname: Perlman, Rachel L organization: Department of Nephrology, University of Michigan, Ann Arbor, MI, USA – sequence: 5 givenname: Roberto surname: Pecoits-Filho fullname: Pecoits-Filho, Roberto organization: Department of Medicine, University of British Columbia, Vancouver, BC, Canada – sequence: 6 givenname: Antonio A surname: Lopes fullname: Lopes, Antonio A organization: Faculdade de Medicina da Bahia School of Medicine, Universidade Federal da Bahia, Salvador, Brazil – sequence: 7 givenname: Ichiei surname: Narita fullname: Narita, Ichiei organization: Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan – sequence: 8 givenname: Helmut surname: Reichel fullname: Reichel, Helmut organization: Nephrological Center, Villingen-Schwenningen, Germany – sequence: 9 givenname: Friedrich K surname: Port fullname: Port, Friedrich K organization: Arbor Research Collaborative for Health, Ann Arbor, MI, USA – sequence: 10 givenname: Nidhi surname: Sukul fullname: Sukul, Nidhi organization: Department of Nephrology, University of Michigan, Ann Arbor, MI, USA – sequence: 11 givenname: Benedicte surname: Stengel fullname: Stengel, Benedicte organization: CESP, Center for Research in Epidemiology and Population Health, Univ Paris-Saclay, Univ Paris-Sud, UVSQ, Inserm UMRS 1018, Villejuif, France – sequence: 12 givenname: Bruce M surname: Robinson fullname: Robinson, Bruce M organization: Arbor Research Collaborative for Health, Ann Arbor, MI, USA – sequence: 13 givenname: Ziad A surname: Massy fullname: Massy, Ziad A organization: CESP, Center for Research in Epidemiology and Population Health, Univ Paris-Saclay, Univ Paris-Sud, UVSQ, Inserm UMRS 1018, Villejuif, France – sequence: 14 givenname: Ronald L surname: Pisoni fullname: Pisoni, Ronald L organization: Arbor Research Collaborative for Health, Ann Arbor, MI, USA |
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| Keywords | chronic kidney disease iron deficiency iron supplementation anemia erythropoiesis-stimulating agents |
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| PublicationTitle | Clinical Kidney Journal |
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| Snippet | BackgroundInternational variation in anemia assessment and management practices in chronic kidney disease (CKD) is poorly understood.Methods We performed a... International variation in anemia assessment and management practices in chronic kidney disease (CKD) is poorly understood. We performed a cross-sectional... Background. International variation in anemia assessment and management practices in chronic kidney disease (CKD) is poorly understood. Methods. We performed a... International variation in anemia assessment and management practices in chronic kidney disease (CKD) is poorly understood.BACKGROUNDInternational variation in... |
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| SubjectTerms | Anemia Chronic kidney failure Complications and side effects Hemoglobin Iron Iron deficiency diseases Kidney diseases Original Physiological aspects |
| Title | Anemia and iron deficiency among chronic kidney disease Stages 3–5ND patients in the Chronic Kidney Disease Outcomes and Practice Patterns Study: often unmeasured, variably treated |
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