A new study demonstrates that there is a high prevalence of anaemia in patients with advanced chronic kidney disease, which increases in the later stages of the disease. The authors suggest that control of anaemia may be achieved with moderate doses of erythropoietin stimulating agent (ESA) and iron therapy, as per current guidelines.
The study analysed data from 504 patients with Stage 3–5 chronic kidney disease who were not on dialysis to determine the prevalence and clinical management of anaemia and iron deficiency. Anaemia was defined as haemoglobin <13.5 g/dL in males and <12 g/ dL in females or patients who receive ESA. Iron deficiency was defined as ferritin <100ng/ml and/or transferrin saturation <20%.
Anaemia was identified in 58.5% of patients, with haemoglobin levels of <11g/dL in 14.9% of these. Among patients with anaemia, 36.3% had iron deficiency of which 53.3% were treated with iron therapy and 12% were not; data was not available for the remaining 34.5%. As chronic kidney disease progressed, presence of anaemia increased (from 35.3% in Stage 3a to 97.5% in Stage 5). Use of ESA also increased throughout disease progression but no difference was observed in the prescribing of iron therapy.
The authors suggest that iron therapy may be under-used in patients with chronic kidney disease and anaemia, especially in those with iron deficiency. They state that increased use of iron therapy in this patient population may optimise erythropoiesis and response to ESA treatment, as highlighted in the updated Kidney Disease Improving Global Outcomes guidelines.
The authors conclude that despite anaemia in chronic kidney disease often being adequately controlled with moderate dosing of ESA and iron therapy, there is still a substantial under treatment of iron deficiency. They recommend that there remain opportunities for improvement in the treatment of these patients.
The full article is available in the March 2014 issue of Nefrologia. For information on the treatment of iron deficiency and anaemia in patients with chronic kidney disease, please click here.