J ZHANG1,2, V DIWAN1,2, Z WANG1,2, S VENUTHURUPALLI2,3, H G HEALY2,4, W E HOY1,2
1University Of Queensland, Brisbane, Australia, 2NHMRC CKD.CRE and CKD.QLD, Brisbane, Australia, 3Kidney Health Service, Toowoomba Hospital, Toowoomba, Australia, 4Kidney Health Service, Royal Brisbane and Women’s Hospital, Brisbane, Australia
Aim: To profile aspects of anaemia management in persons with pre-dialysis chronic kidney disease (CKD).
Anaemia in CKD, diagnosed when haemoglobin is 130 g/l in males and <120 g/l in females, is associated with poor health outcomes.
Methods: Adults with CKD from two sites of the CKD.QLD Registry (for pre-dialysis CKD patients in the Queensland public health system) (Toowoomba [TWMBA, n=1,054] and MetroNorth [MN, n=1,643]), were characterised at consent and followed until start of RRT or death, or the censor date (June 2018). Mean follow-up was 3.4 years and 4.0 years at these sites respectively.
Results: Over follow-up (TWMBA/MN), 17.5%/12.4% of participants received erythropoiesis-stimulating agents (ESAs), 12.7%/20.4% received iron infusions and 22.7%/25.3% received blood transfusions. Proportions of patients receiving these therapies were higher with more advanced anaemia and more advanced stages of CKD, and highest in those with diabetic-nephropathy (all p<0.01). Mean follow-up after starting these therapies (TWMBA/MN) was 12.2 months/15 months for those receiving ESAs, 7 months/10 months for iron infusions and 4.6 months/7.7 months for blood transfusions. Mean haemoglobin levels increased after ESA treatment (103 vs 109 / 94 vs 105) (p<0.001). However, almost 50%/40% of patients, respectively, had a <5% increase in haemoglobin level. ESA responses were best in patients with glomerulonephritis (mean increases: 11.8%/17.2%), and worst in those with diabetic-nephropathy (5.8%/4.6%). Most frequently used ESAs were Darbepoetin Alfa in TWMBA and Epoetin Alfa in MN.
Conclusion: Good responses to ESAs are not assured in anaemic CKD patients and high proportions require blood transfusions, with risk of adverse reactions and allosensitisation. Additional treatments are needed to support adequate erythropoiesis in this high risk group.
Supported by AstraZeneca.
Dr Jenny Zhang is a Research Fellow with Centre for Chronic Disease, Faculty of Medicine of The University of Queensland. She has experience in health service research in chronic diseases with a strong background in quantitative research methodology and data analysis.