Prevalence, treatment patterns, and healthcare resource utilization in Medicare and commercially insured non-dialysis-dependent chronic kidney disease patients with and without anemia in the United States

Wendy L. St Peter, Haifeng Guo, Shaum Kabadi, David T. Gilbertson, Yi Peng, Trudy Pendergraft, Suying Li

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background: Anemia is common in non-dialysis-dependent chronic kidney disease (NDD-CKD) patients, but detailed information on prevalence and treatment is lacking. Methods: We evaluated anemia prevalence and treatment using two datasets: the Medicare 20% random sample (ages 66-85 years), and the Truven Health MarketScan database (ages 18-63 years). We selected stage 3-5 NDD-CKD patients with and without anemia from both databases during 2011-2013. We evaluated anemia prevalence and treatment (erythropoietin stimulating agents [ESAs], intravenous [IV] iron, red blood cell [RBC] transfusions) following anemia diagnosis during a 1-year baseline period, and healthcare utilization during a 1-year follow-up period. We used Poisson regression models to compare healthcare utilization in patients with and without anemia, adjusting for demographics, baseline comorbid conditions, inflammatory conditions, and CKD stage. Results: We identified 218,079 older and 56,188 younger stage 3-5 NDD-CKD patients. Anemia prevalence increased with age in both datasets; was higher in women, black patients (Medicare only), and patients with comorbid conditions; and rose sharply with increasing CKD stage. Of 15,716 younger anemic patients, 11.7%, 10.8%, and 9.4% were treated with RBC transfusion, ESAs, and IV iron, respectively. Corresponding proportions of 109,251 older anemic patients were 22.2%, 12.7%, and 6.7%. Regardless of age, anemic patients were more likely than non-anemic patients to use healthcare resources, including hospitalizations and emergency department, hematologist, nephrologist, and outpatient visits. Anemic NDD-CKD patients were more likely to be treated with RBC transfusion than with ESAs or IV iron. Conclusion: More research is necessary to determine best approaches to anemia management in CKD.

Original languageEnglish (US)
Article number67
JournalBMC Nephrology
Volume19
Issue number1
DOIs
StatePublished - Mar 15 2018

Bibliographical note

Funding Information:
This work was supported by a research contract from AstraZeneca, Inc., Wilmington, Delaware. The contract provides for the Minneapolis Medical Research Foundation authors to have final determination of manuscript content.

Keywords

  • Anemia
  • Anemia treatment
  • Healthcare utilization
  • Non-dialysis-dependent chronic kidney disease

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