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
Main Authors: Wong, Michelle M Y, Tu, Charlotte, Li, Yun, Perlman, Rachel L, Pecoits-Filho, Roberto, Lopes, Antonio A, Narita, Ichiei, Reichel, Helmut, Port, Friedrich K, Sukul, Nidhi, Stengel, Benedicte, Robinson, Bruce M, Massy, Ziad A, Pisoni, Ronald L
Format: Journal Article
Language:English
Published: England 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.
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
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/32905241$$D View this record in MEDLINE/PubMed
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ContentType Journal Article
Copyright The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA. 2019
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The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
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Issue 4
Keywords chronic kidney disease
iron deficiency
iron supplementation
anemia
erythropoiesis-stimulating agents
Language English
License This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
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The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA.
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See Acknowledgements section for CKDopps Investigators.
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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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StartPage 613
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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