Drug treatment patterns and work productivity in chronic kidney disease patients with anemia in China: Cross sectional analysis of real-world data

Abstract

Background: We explored the association of anemia severity in patients with chronic kidney disease (CKD) and anemia treatment with work productivity in China.

Methods: Cross-sectional survey data from Chinese physicians and their CKD patients were collected in 2015. Physicians recorded demographics, disease characteristics, and treatment. Patients completed the Work Productivity and Activity Impairment questionnaire. Data were stratified by dialysis-dependence, hemoglobin (Hb) level, and anemia treatment.

Results: Based on data from 1,052 patients (704 non-dialysis-dependent [NDD] and 348 dialysis-dependent [DD] patients), prescribed anemia treatment differed significantly across Hb levels (P < 0.001). In NDD patients, anemia treatment also differed significantly by on-treatment Hb level (P < 0.001). In treated NDD patients with Hb < 10 g/ dL, Hb 10 to 12 g/dL, and Hb > 12 g/dL, 31%, 59%, and 38% of patients, respectively, were prescribed oral iron, and 34%, 19%, and 0% of patients, respectively, were prescribed oral iron with erythropoiesis-stimulating agents (ESA). NDD patients were less likely to be prescribed any anemia treatment, and ESA specifically, than DD patients. When treated, 67% and 45% of NDD and DD patients, respectively, had Hb ≥ 10 g/dL (P < 0.001). Overall work and activity impairment differed significantly across Hb levels in NDD and DD patients, with the least impairment observed at the highest Hb level.

Conclusion: Approximately 40% of NDD patients and 60% of DD patients receiving anemia treatment had Hb < 10 g/dL. Compared with mild anemia patients, severe anemia patients were more likely to be treated for anemia and have impaired work productivity. Chinese CKD patients could benefit from improved anemia treatment.

Keywords: Anemia; China; Chronic kidney diseases; Hematinics; Iron; Observational study.

Figure 1. Prescribed anemia treatment.

(A) overall % of patients receiving anemia treatment, (B) % of patients receiving specified anemia treatments. ^aTreatment details were not reported for all patients receiving treatment, hence these numbers are lower than those shown in Fig. 1A. P values are the results of analysis of variance (ANOVA) comparing differences in anemia treatments across hemoglobin (Hb) levels. DD, dialysis-dependent; ESA, erythropoietin-stimulating agent; NDD, non-dialysis-dependent.

Figure 2. Regression plot of probability of any anemia treatment being prescribed, by hemoglobin (Hb) level and dialysis status.

Shaded regions show 95% confidence intervals for each plotted line. n = 990; Hb: P < 0.001; NDD/DD: P < 0.001. DD, dialysis-dependent; NDD, non-dialysis-dependent.

Figure 3. Regression plot of probability of erythropoietin-stimulating agent (ESA) being prescribed by hemoglobin (Hb) level and dialysis status.

Shaded regions show 95% confidence intervals for each plotted line. n = 877; Hb: P < 0.001; NDD/DD: P < 0.001. DD, dialysis-dependent; NDD, non-dialysis-dependent.

Figure 4. Regression plot of probability of iron being prescribed by hemoglobin (Hb) level and dialysis status.

Shaded regions show 95% confidence intervals for each plotted line. n = 877; Hb: P < 0.001; NDD/DD: P < 0.001. DD, dialysis-dependent; NDD, non-dialysis-dependent.

Figure 5. Work Productivity and Activity Impairment-Specific Health Problem (WPAI-SHP) domain scores by current hemoglobin (Hb) level.

P values are the results of analysis of variance (ANOVA) comparing productivity impairment across Hb levels. DD, dialysis-dependent; NDD, non-dialysis-dependent.