Only a subset of patients with nondialysis-dependent chronic kidney disease (NDD-CKD) initiate anemia medication despite clinical signs indicating treatment, according to investigators presenting at the American Society of Nephrology’s Kidney Week 2020 Reimagined virtual conference.

A team led by Marcelo Lopes, MD, PhD, MPH, of the University of Michigan in Ann Arbor, examined real-world trends in anemia treatment using prospective data from 2818 patients from Brazil, Germany, and the United States in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDOPPS).

Overall, only 708 patients (25%) received anemia prescriptions during follow-up. The cumulative incidence function of any anemia medication initiation at 12 months was 40% for patients with hemoglobin (Hb) less than 10 g/dL, Dr Lopes reported. For oral iron therapy, cumulative incidence was 26% for patients with transferrin saturation (TSAT) less than 20% and 22% for patients with serum ferritin less than 100. For intravenous iron, cumulative incidence was 6% and 4%, respectively. For erythropoiesis stimulating agents (ESA), cumulative incidence was 38% for patients with Hb less than 10 g/dL and 11% for patients with Hb 10 to less than 12 g/dL.

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Medications are only started at the later stages of CKD, Dr Lopes reported. Patients with heart failure are more likely to be treated promptly for anemia, he said.

Oral iron was the most frequent prescription overall. For reasons that have yet to be clarified, a third of new users discontinued their anemia medications within 12 months of initial prescription.

“These longitudinal data support the concept that anemia is suboptimally managed among patients with NDD-CKD in the real-world setting,” Dr Lopes said. “These data point to an opportunity for enhanced detection and improved management.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Lopes M, Tu C, Zee J, et al. Real-world longitudinal analysis of anemia treatment prescriptions in non-dialysis-dependent CKD patients, a CKDopps study. Presented at: Kidney Week Reimagined; October 19-25, 2020. Poster presentation TH-OR10.