QUESTION: This study aimed to describe the routine clinical management of patients with NDD-CKD and anaemia following ESA initiation, in Germany, Spain and the UK.
METHODS: This was a non-interventional cohort study of adults with NDD-CKD stages 3b–5 diagnosed with anaemia (haemoglobin [Hb] <13.0 g/dL [males] or <12.0 g/dL [females]), who began ESA treatment Jan 2015–Dec 2015. Data for ≤24 months after ESA initiation were extracted from medical records.
RESULTS: 848 patient records (Germany, 211; Spain, 430; UK, 207) were included. Patient characteristics and management patterns are shown in the Table. Hb levels were recorded at ESA initiation for most (91.3%) patients and averaged 9.8 ± 1.0 g/dL for the total cohort (Table). Mean ± SD estimated glomerular filtration rate at ESA initiation was 28.0 ± 10.4 ml/min/1.73m2. Across countries, 72–88% of patients received ESAs at home. The mean ± SD duration of therapy (at the time of data collection) was 41.2 ± 18.2 months, and the median weekly dose of short-acting and long-acting ESAs was 3.238 IU and 20 μg, respectively. During their initial course of therapy, three-quarters of patients had either an increase or decrease in ESA dose. Less than 10% of patients switched ESAs, while approximately one-third discontinued within 2 years of initiation. At 3 and 6 months post-ESA initiation, only 64.7% of the sample had a documented Hb measurement despite continuing ESA treatment; and this reduced to 60.0% by 12 months after initiation. The Hb target was maintained by 88.7%, 74.6% and 49.4% of patients at 3, 6 and 12 months, respectively. Mean ferritin levels were 167.3 ng/mL at initiation and 198.7 ng/mL at 12 months (among the 85% and 48% of the sample, respectively, with recorded data). Mean transferrin saturation was 22.1% at initiation and 25.6% at 12 months (among the 67% and 38%, respectively, with recorded data). Approximately three-quarters of patients (77.3%) received iron therapy concomitantly with ESA treatment; in the UK, most received IV iron, while in Germany and Spain, a majority received oral iron. Blood transfusions were more common in Spain (24.2%) than in Germany (5.1%) or the UK (8.4%). Approximately one-fifth of patients required dialysis.
CONCLUSION: Initiation of ESAs to treat anaemia among patients with NDD-CKD in Germany, Spain and the UK followed current guidelines. However, recommendations to regularly monitor Hb were not routinely followed or were poorly documented. As most patients with NDD-CKD anaemia were treated at home, a simple treatment regimen oral therapies may be of benefit to these patients.
