Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2018 Mar 15;19(1):67.
doi: 10.1186/s12882-018-0861-1.

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  1   2 , Haifeng Guo  3 , Shaum Kabadi  4 , David T Gilbertson  3 , Yi Peng  3 , Trudy Pendergraft  4 , Suying Li  3
Affiliations
Observational Study

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 et al. BMC Nephrol. .

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.

Keywords: Anemia; Anemia treatment; Healthcare utilization; Non-dialysis-dependent chronic kidney disease.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

We applied to and received approval from the Human Subjects Research Committee of the Hennepin County Medical Center/Hennepin Healthcare System, Inc. We used retrospective data from the Truven Health MarketScan database and CMS Medicare data under data use agreements and obtained a waiver of consent as obtaining consent would have been an unreasonable burden.

Consent for publication

Not applicable.

Competing interests

Drs. St. Peter, Gilbertson, and Li, Ms. Guo, and Mr. Peng report no competing financial interests. Dr. Kabadi and Ms. Pendergraft are employed by AstraZeneca. The results presented in this paper have not been published previously in whole or part, except in abstract format.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study design for 2012 cohorts of Medicare-covered and commercially insured (MarketScan) stage 3–5 non-dialysis-dependent chronic kidney disease patients. CKD, chronic kidney disease
Fig. 2
Fig. 2
Proportion of stage 3–5 non-dialysis-dependent chronic kidney disease patients with anemia treated with erythropoietin-stimulating agents, intravenous iron and/or red blood cell transfusion. Panel (a), Medicare-covered patients aged 66–85 years; panel (b), Commercially insured patients aged 18–63 years. ESA, erythropoietin-stimulating agents; IV, intravenous
Fig. 3
Fig. 3
Adjusted hazard ratios of healthcare utilization in stage 3–5 non-dialysis dependent chronic kidney disease patients with and without anemia. Panel (a), Medicare-covered patients aged 66–85 years; panel (b), commercially insured patients aged 18–63 years. Results were from Poisson regression models with number of each type of health service as the dependent variable adjusting for patient demographics, baseline comorbidities, inflammatory conditions, and CKD stage. CKD, chronic kidney disease; ED, emergency department; OP, outpatient. *P < 0.05
See this image and copyright information in PMC

References

    1. Astor BC, Muntner P, Levin A, Eustace JA, Coresh J. Association of kidney function with anemia: the third National Health and nutrition examination survey (1988-1994) Arch Intern Med. 2002;162:1401–1408. doi: 10.1001/archinte.162.12.1401. - DOI - PubMed
    1. Stauffer ME, Fan T. Prevalence of anemia in chronic kidney disease in the United States. PLoS One. 2014;9:e84943. doi: 10.1371/journal.pone.0084943. - DOI - PMC - PubMed
    1. Thamer M, Zhang Y, Kshirsagar O, Cotter DJ, Kaufman JS. Erythropoiesis-stimulating agent use among non-dialysis-dependent CKD patients before and after the trial to reduce cardiovascular events with Aranesp therapy (TREAT) using a large US health plan database. Am J Kidney Dis. 2014;64:706–713. doi: 10.1053/j.ajkd.2014.05.013. - DOI - PMC - PubMed
    1. Pfeffer MA, Burdmann EA, Chen CY, Cooper ME, de Zeeuw D, Eckardt KU, et al. A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med. 2009;361:2019–2032. doi: 10.1056/NEJMoa0907845. - DOI - PubMed
    1. Drueke TB, Locatelli F, Clyne N, Eckardt KU, Macdougall IC, Tsakiris D, et al. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med. 2006;355:2071–2084. doi: 10.1056/NEJMoa062276. - DOI - PubMed

Publication types

MeSH terms