Kidney Week

Abstract: TH-PO917

Treatment of Clinically Meaningful Anemia by Prescriber Type in Nondialysis-Dependent CKD Patients in the United States

Session Information

• Anemia and Iron Metabolism
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Anemia and Iron Metabolism

• 200 Anemia and Iron Metabolism

Authors

• Petersen, Jeffrey, Amgen Inc, Thousand Oaks, California, United States

Jeffrey Petersen, MD

• Ma, Junjie, Amgen Inc, Thousand Oaks, California, United States

Junjie Ma, MSc, PhD

• Moore, Carol, Amgen Inc, Thousand Oaks, California, United States

Carol Moore, PharmD

• Weir, Matthew R., University of Maryland School of Medicine, Baltimore, Maryland, United States

Matthew R. Weir, MD

• Berns, Jeffrey S., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States

Jeffrey S. Berns, MD, FASN

• Toto, Robert D., The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Robert D. Toto, MD

Background

Anemia management in patients with non-dialysis dependent chronic kidney disease (NDD-CKD) remains suboptimal due to a lack of data to further understand the potential barriers. This study investigated anemia treatment patterns by prescriber type in NDD-CKD patients with clinically meaningful anemia (hemoglobin [Hb] < 10 g/dL).

Methods

This retrospective cohort study used the Optum electronic health record database (Jan 2015–Dec 2022) to describe the treatment of NDD-CKD anemia with red blood cell transfusion (RBCT), intravenous (IV) iron, or erythropoiesis stimulating agents (ESAs). Inclusion criteria included: age ≥ 18 years at CKD diagnosis, stage 3–5 CKD, ≥ 2 Hb measurements < 10 g/dL, and treatment-naïve for anemia. The date of first Hb result < 10 g/dL was the index date for anemia diagnosis. Temporal trends of anemia treatment patterns were analyzed and stratified by prescriber type.

Results

Overall, 88,917 NDD-CKD patients (mean [SD]: age, 73.9 [10.5] years; baseline Hb, 9.1 [0.6] g/dL) were included. During the follow-up (median [25^th–75^th percentile], 1.34 [0.50–2.94] person years), two-thirds of patients received no treatment. Among patients prescribed treatment at the index date, 20% received RBCT, 7% IV iron, and 8% an ESA; after index, 23% received RBCT, 9% IV iron, and 13% ESAs, alone or in combination. Among patients treated at index, 8% and 4% continued to receive treatment at 1- and 2-year follow-up, respectively. At 3 months, 61% and 30% of patients received RBCT or ESAs, versus 39% and 62%, respectively, at 1 year (Fig A). Among the 5 most common prescriber types, internists, surgeons, and oncologists prescribed RBCT to ~60% and nephrologists to 28% of patients (Fig B). ESAs (epoetin alfa and darbepoetin alfa combined) were prescribed to 25% and 50% of patients by oncologists and nephrologists, respectively.

Conclusion

A large proportion of NDD-CKD patients with clinically meaningful anemia remained untreated. RBCT was the most common initial treatment versus ESAs which increased with longer follow-up. Treatment patterns varied by prescriber type with nephrologists prescribing ESAs most frequently.

Funding

• Commercial Support – Amgen Inc.