For patients with diabetes and CKD, those with untreated anemia are more likely to be hospitalized.
CHICAGO—Diabetics with CKD whose anemia is untreated have twice the overall risk of CVD-related hospitalizations, according to data reported at the 67th Scientific Sessions of the American Diabetes Association.
“For practicing physicians, these findings highlight the importance of adherence to guidelines regarding the treatment of anemia in patients with diabetes and CKD,” said Patrick Lefebvre, MA, senior economist at Groupe d’Analyse in Montreal.
Lefebvre and colleagues analyzed health claims and laboratory data from 708 patients treated over a recent five-year period in a managed-care setting. The data were obtained from a registry that includes complete medical histories for more than 25 million individuals enrolled in over 30 health plans covering all census regions of the United States.
“Anemia is a common complication of CKD disease and is associated with functional declines and increased health-care costs,” Lefebvre pointed out, adding that both diabetes and anemia are CVD risk factors. CVD is the leading cause of mortality in the United States, and heart failure is the leading cause of hospitalization. In 2003, the estimated cost of coronary heart disease and associated complications was $403.1 billion, he said.
Adult patients were included in the analysis if they had at least two claims for diabetes within a 90-day period preceding:
- at least one claim for CKD
- at least two glomerular filtration rate values of less than 60 mL/min/1.73 m2
- at least two hemoglobin laboratory results.
Compared with patients who did not have anemia, those with untreated anemia had a twofold increased risk of first hospitalization for any cause and first CVD-related hospitalization. After controlling for multiple potential confounding factors, untreated anemia remained significantly associated with an increased risk of any hospitalization and CVD-related hospitalization.
Lefebvre and colleagues emphasized that the data need to be interpreted cautiously in light of potential study limitations. “For example, claims data have inherent limitations such as inaccuracies in billing diagnosis and missing data on laboratory results,” he said. “Also, the lack of randomization in an observational study such as this one may cause confounding in the untreated anemia and non-anemia patients.
“Finally,” he continued, “because laboratory results and diagnoses were not collected at pre-specified intervals as in randomized clinical trials, false-negatives of CKD and anemia could have occurred in patients who did not seek care, especially in those who did not have symptomatic manifestations.”
Despite potential limitations, Lefebvre emphasized that the findings confirm similar results from prior studies of a selected population of patients suffering from both diabetes and CKD.