Patients with nondialysis-dependent chronic kidney disease (CKD) commonly receive red blood cell (RBC) transfusions, despite the risk for hyperkalemia and complications, according to poster presentation at the National Kidney Foundation’s 2023 Spring Clinical Meetings in Austin, Texas.

Investigators identified 10,712 patients with stage 3 to 5 CKD in Optum’s de-identified Integrated Claims-Clinical dataset and 64,554 patients in a Medicare Advantage database. Mean age was 58.8 years in the commercial insurance cohort and 20 years higher, 77.8 years in the Medicare Advantage cohort. The comorbidity burden was higher among Medicare Advantage patients.

Overall, 5.7% of commercial insurance patients and 4.9% of Medicare Advantage patients had RBC transfusion. Transfusion rates at 6 months ranged from approximately 50% of patients with a hemoglobin level less than 7.0 g/dL to 2%-3% of patients with a hemoglobin level of 11.0 g/dL or higher, Jake Hunnicutt, PhD, MPH, and colleagues from GSK in Collegeville, Pennsylvania, reported.

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Only 1.2% of patients received erythropoiesis-stimulating agents (ESAs) and 2.8% and 2.1% received intravenous iron in the commercial insurance and Medicare Advantage groups, respectively. Many patients with CKD did not receive any anemia treatment.

Hyperkalemia occurred within 30 days of RBC transfusion in 12.7% and 12.1% of commercial insurance and Medicare Advantage patients with CKD. Hospitalization within 30 days of RBC transfusion was required for 35.8% and 46.1% of patients, respectively.

Disclosure: This research was supported by GSK. Please see the original reference for a full list of disclosures.


Hunnicutt J, Ma L, Mu G, et al. Red blood cell (RBC) transfusion use varies by baseline hemoglobin (Hb) and is associated with post-transfusion hyperkalemia and hospitalization within 30 days in US patients with stage 3–5 CKD and anemia.Presented at: NKF 2023, Austin, Texas, April 11-15. Abstract 182.