ORLANDO, Fla.—In patients with non-dialysis-dependent chronic kidney disease (NDD-CKD), the risk of anemia increases as renal function declines. At the National Kidney Foundation’s 2017 Spring Clinical Meetings, Steven M. Brunelli, MD, of DaVita Clinical Research in Minneapolis, and colleagues studied hemoglobin (Hb) levels in 26,833 NDD-CKD patients (17,559 with stage 3A, 6848 with stage 3B, 1976 with stage 4, and 450 with stage 5 CKD).
Dr Brunelli’s team defined CKD stages based on estimated glomerular filtration rate (in mL/min/1.73 m2): 45–59 (stage 3A), 30–44 (stage 3B), 15–29 (stage 4), and less than 15 (stage 5). Anemia is traditionally defined as Hb levels below 12 g/dL in women and below 13 g/dL in men, with current guidelines suggesting erythropoietin-stimulating agents (ESAs) not be considered until Hb falls below 10 g/dL.
Among patients with CKD stages 3A, 3B, 4, and 5, the proportion of patients with Hb levels of 10–12 g/dL was 20.3%, 36.4%, 48.8%, and 49.3%, respectively, the researchers reported in a poster presentation. The proportion of patients with Hb levels of 9–9.9 g/dL was 1.6%, 3.7%, 9.9%, and 15.6%, respectively. The proportion of patients with an Hb level below 9 g/dL was 0.8%, 1.4%, 4.6%, and 12%, respectively. Among patients with CKD stages 3–4, more severe anemia was associated with younger age and male gender, according to the investigators. Among patients with stage 5 CKD, more severe anemia was associated with older age and female gender.
Among patients with CKD stages 3–4, the proportion of women was lowest among patients with Hb levels less than 9 g/dL (53.9%–64.9%) and 13 g/dL or higher (40.7%–49.1%) compared with the proportions of women among patients with Hb levels of 10–12.9 g/dL (60.9%–74.9%). In CKD stage 5, the proportion of women was highest (51%–52%) in Hb categories less than 12.1 g/dL).
Additionally, among patients with CKD stage 3B, the prevalence of congestive heart failure increased as Hb level decreased. The prevalence of coronary artery disease in this group was highest among patients with Hb levels below 10 g/dL compared with higher Hb categories.
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Brunelli SM, Kabadi S, Catini J, et al. Characterizing the burden of anemia among non-dialysis-dependent CKD patients. Poster presented at the National Kidney Foundation 2017 Spring Clinical Meetings in Orlando, Florida. Poster 167