P1372PRE-DIALYSIS HAEMOGLOBIN TARGET ATTAINMENT AND POST-DIALYSIS OUTCOMES IN PERSONS WITH RENAL ANAEMIA: A NATIONWIDE STUDY
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Abstract Background and Aims Attaining the narrow hemoglobin range (10-12 g/dL) recommended by current ERBP renal anemia guidelines may be difficult, and whether this leads to better outcomes is not well known. This study aimed to identify patient and clinical factors associated with difficulties in maintaining hemoglobin target ranges in routine non-dialysis nephrologist care. We also evaluated whether adherence to ERBP hemoglobin recommendations during pre-dialysis care predicted early post-dialysis outcomes. Method Observational study from the Swedish Renal Registry including all patients with non-dialysis dependent CKD stages 3b-5 developing renal anemia or initiating treatment (iron, ESA or both) between 2012-2016. Through multinomial logistic regression with clustered variance, we identified clinical conditions associated to serum hemoglobin values outside the ERBP recommended range (<10 and >12 g/dL) throughout all recorded patient visits until death, dialysis or end of follow-up. For those who initiated dialysis, we calculated the proportion of patient-time in which hemoglobin was maintained within range (time in range [TIR]). We then explored associations between TIR and subsequent one-year risk of death or MACE (composite of death caused by CVD and non-fatal MI, stroke, heart failure) with Cox proportional hazards regression. Results A total 8106 patients with CKD 3b-5 developed incident anemia in Sweden during 2012-2016, contributing with 37422 nephrology visits during median 2 years of follow up. In multinomial logistic regression, being a man and having received iron or higher ESA doses was associated with hemoglobin values outside target range. Patients with CKD 3b and 4, ongoing transplant, history of CVD, or with higher serum calcium and albumin levels had higher odds of maintaining hemoglobin values above range. Conversely, recent bleeding or transfusions, nephrosclerosis, inflammation (CRP>5 mg/dl), and higher phosphate levels increased the odds of having hemoglobin values below range. A total 2435 patients initiated maintenance dialysis during the study period. Of those, 327 died and 701 developed MACE during the subsequent year. Their median TIR during their pre-dialysis period was 44% (IQR: 34-50). On a continuous scale (FIGURE), we observed worse outcomes for patients with poor guideline recommendation adherence (low percentage TIR), although the association was judged weak. On a categorical scale, patients that spent more than 40% of their pre-dialysis TIR had lower hazards of death (0.57, 95% CI 0.41-0.80) and MACE (0.67, 95% CI, 0.54-0.84) compared to those with <44% TIR. Conclusion This nationwide study reports that greater adherence to ERBP anemia guidelines during pre-dialysis care, using existing conventional therapeutic approaches, is associated with better post-dialysis outcomes. Whether active interaction by healthcare practitioners affected the observed relationship needs to be further explored.Keywords:
Nephrology
Anemia is one of the many complications of chronic kidney disease (CKD). However, the current prevalence of anemia in CKD patients in the United States is not known. Data from the National Health and Nutrition Examination Survey (NHANES) in 2007–2008 and 2009–2010 were used to determine the prevalence of anemia in subjects with CKD. The analysis was limited to adults aged >18 who participated in both the interview and exam components of the survey. Three outcomes were assessed: the prevalence of CKD, the prevalence of anemia in subjects with CKD, and the self-reported treatment of anemia. CKD was classified into 5 stages based on the glomerular filtration rate and evidence of kidney damage, in accordance with the guidelines of the National Kidney Foundation. Anemia was defined as serum hemoglobin levels ≤12 g/dL in women and ≤13 g/dL in men. We found that an estimated 14.0% of the US adult population had CKD in 2007–2010. Anemia was twice as prevalent in people with CKD (15.4%) as in the general population (7.6%). The prevalence of anemia increased with stage of CKD, from 8.4% at stage 1 to 53.4% at stage 5. A total of 22.8% of CKD patients with anemia reported being treated for anemia within the previous 3 months–14.6% of patients at CKD stages 1–2 and 26.4% of patients at stages 3–4. These results update our knowledge of the prevalence and treatment of anemia in CKD in the United States.
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Anemia is a common complication of chronic kidney disease (CKD) and a predictor of increased mortality. This project integrated erythropoietin-stimulating agent (ESA) with CKD care under one practice setting, co-managing anemia with CKD while reducing frequency of office visits in a rural setting. Patients self-administered their weekly dosage of erythropoietin with monthly follow-ups. As a result, office visits decreased by 56% for patients with CKD Stage 4 and by 54% for patients with CKD Stage 5.
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<i>Background:</i> Some patients who reach end-stage renal disease refuse to start dialysis at the time suggested by their nephrologist and delay it. Whether this delay may affect health-related quality of life (HRQoL), clinical and biological parameters at dialysis onset, and then survival and hospitalization during dialysis is unknown. <i>Methods:</i> We considered all adult patients who began dialysis in Lorraine (France) in 2005–2006 having previously been followed by a nephrologist. Clinical and biological characteristics at dialysis onset were collected from medical records, and nephrologists were interviewed about compliance with the recommended starting date. HRQoL was measured using the French version of the ‘Kidney Disease Quality of Life’ V36 questionnaire. Mortality and total duration of hospitalization during the first year of dialysis were recorded as part of the end-stage renal disease French registry. The effects of delaying dialysis on survival and on duration of hospitalization were determined using log-rank test and polychotomous logistic regression, respectively. <i>Results:</i> Of 541 patients, 88 (16.3%) declined to initiate dialysis at the time recommended by the nephrologist and delayed it. Compared with patients who were compliant with the advice, noncompliers had more comorbidities, poorer clinical and biological profiles at dialysis start, and a higher risk of beginning dialysis in emergency circumstances with greater decline in the ‘burden of kidney disease’ dimension of HRQoL. However, there were no differences in survival or duration of hospitalization during dialysis. <i>Conclusion:</i> Despite a negative effect on clinical and biological parameters at initiation, delaying dialysis did not impact on survival during treatment.
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The prevalence of chronic kidney disease (CKD), especially the early stages, is still not exactly known. This is also true for CKD stage 3, when cardiovascular and other major complications generally appear. The NANHES data have shown a steady increase in the prevalence of CKD 3 up to 7.7% in 2004. Chronic kidney disease and renal failure are underdiagnosed all over the world. In Italy, prevalence estimates for stage 3 to 5 CKD are around 4 million yet, less than 30% of these subjects are believed to be followed at nephrology clinics. This means that in Italy for every dialyzed patient there are about 85 individuals with possibly progressive kidney disease, while fewer than five (mainly stage 4 and 5 patients) are actually followed by a nephrologist.
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Chronic kidney disease (CKD) is one of world health problems because the prevalence that keeps increasing each year. Anemia is one of the major problems in patients with chronic kidney disease. Anemia can occur in patient with CKD because when damaged, the kidney can’t produce enough erythropoietin. The purpose of this article is to determine whether there is a relationship between anemia with CKD. This type of article is a study of literature from various national and international journals. The method used to present, increase knowledge and understanding of the topics discussed by summarizing published material and providing new factual information or analysis from the relevant literature and the comparing the results in articles. The results of the literature study show that there is a relationship between anemia with CKD, which is characterized by a decrease in hemoglobin in CKD patients. The prevalence of CKD according to gender, mostly occurred in men (0,3%) than women (0,2%).In addition, the highest age prevalence was in the age group 75 years (0,6)%. This is related to the risk factor for CKD. To reduce anemia in CKD patients, erythropoiesis stimulating agent therapy can be given which aims to correct anemia renal until the hemoglobin target is achieved.
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Chronic kidney disease (CKD) as defined by an estimated glomerular filtration rate (eGFR) of <60 ml/min/1.73 sq. m BSA affects about 20 million Americans. Existing CKD care models are predicated on Adult Primary Care referrals to Nephrology Clinics of patients with this arbitrary CKD staging criterion. Increasing referrals of CKD patients have far surpassed the capacity of Nephrology Clinics. Arguably, since most CKD patients remain stable over the years, Nephrology Clinic visits may represent expensive unnecessary care in the majority of referrals.
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Abstract Chronic kidney disease (CKD) represents a public health burden worldwide and is associated with significant morbidity and mortality. Most patients with CKD are managed by primary care practitioners and this educational series hope to improve knowledge and delivery of care to this high-risk patient population with CKD.
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The prevalence of chronic kidney disease (CKD), especially the early stages, is still not exactly known. This is also true for CKD stage 3, when cardiovascular and other major complications generally appear. The NANHES data have shown a steady increase in the prevalence of CKD 3 up to 7.7% in 2004. Chronic kidney disease and renal failure are underdiagnosed all over the world. In Italy, prevalence estimates for stage 3 to 5 CKD are around 4 million yet, less than 30% of these subjects are believed to be followed at nephrology clinics. This means that in Italy for every dialyzed patient there are about 85 individuals with possibly progressive kidney disease, while fewer than five (mainly stage 4 and 5 patients) are actually followed by a nephrologist.
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