Prevalence and Management of Anemia Among Patients with Chronic Kidney Disease in a Health Maintenance Organization
Annamaria T. Kausz
Earl P. Steinberg
Allen R. Nissenson
Brian J.G. Pereira
Background: Anemia often develops among patients with chronic kidney disease (CKD) and is an important cause of cardiovascular disease among patients with end-stage renal disease (ESRD). Objective: To evaluate the epidemiology and treatment of anemia among patients with CKD by undertaking an analysis of data from one Health Maintenance Organization. Methods: The CKD cohort was comprised of 1658 patients followed between 1 January 1994 and 1 December 1997 who had serum creatinine (SCr) levels above gender-specific norms. The prevalence of anemia and epoetin-alpha (recombinant human erythropoietin) use was determined, and the association with anemia and kidney function was assessed with multinomial logistic regression analysis. Results: 36% of patients with CKD had anemia, with at least two hematocrit (HCT) values (separated by >=30 days) lower than the gender-specific norm (<42% for males, <36% for females). Eleven per cent of patients had a lowest HCT value less than the gender-specific norm but >=33%, 6% had a lowest HCT value 30 to 32.9%, and 19% had a lowest HCT value <30%. The prevalence of anemia was positively correlated with the severity of kidney dysfunction. In the multivariate analysis, the independent relative risk of an HCT value <30% versus no anemia was 84.5, 9.8 and 2.0 for patients with SCr level >=4.0, 3.0 to 3.9 and 2.0 to 2.9 mg/dl, respectively, compared with patients with SCr level <2.0 mg/dl. Epoetin-alpha was prescribed for only 7.4% of patients and, more significantly, for only 23% of patients with an HCT value <30%. Even among patients with an HCT value <30% who had received care from a nephrologist, only 66% received epoetin-alpha. Conclusions: This study demonstrates that the prevalence of anemia among patients with CKD is high and the management of anemia is suboptimal. Suboptimal treatment of anemia during CKD may lead to increased cardiovascular morbidity and cost of care among patients with CKD and ESRD.
Anaemia, Antianaemics, Drug utilisation, Epoetin alfa, Pharmacoeconomics
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