Prevalence of anaemia in adults with chronic kidney disease in a representative sample of the United States population: analysis of the 1999-2018 National Health and Nutrition Examination Survey

Abstract

Background: Population-based estimates of anaemia prevalence in patients with chronic kidney disease (CKD) vary, and data on the prevalence of severe anaemia of CKD are limited. This study examined the prevalence of anaemia and anaemia eligible for erythropoiesis-stimulating agent (ESA) treatment in patients with CKD in the USA.

Methods: National Health and Nutrition Examination Survey (NHANES) data from 1999-2000 to 2017-18 were used to determine the prevalence of diagnosed anaemia (haemoglobin <12 g/dL in women; <13 g/dL in men) and anaemia eligible for ESA treatment (haemoglobin <10 g/dL) in survey participants aged ≥18 years with stage 3-5 non-dialysis-dependent CKD (estimated glomerular filtration rate <60 mL/min/1.73 m²). The study objectives were to (i) obtain a more recent estimate of anaemia prevalence in patients with non-dialysis-dependent CKD and (ii) examine the characteristics of individuals with CKD and haemoglobin <10 g/dL.

Results: Of 51 163 eligible NHANES participants, 2926 (5.7%) with stage 3-5 CKD were included. In all participants, the weighted prevalences of anaemia and haemoglobin <10 g/dL were 25.3% and 1.9%, respectively. Mean haemoglobin levels decreased numerically between 1999 and 2012 and remained stable thereafter. The prevalence of anaemia and haemoglobin <10 g/dL increased with advancing CKD stage. The odds of haemoglobin <10 g/dL were significantly higher in stage ≥3B versus 3A and in non-Hispanic Blacks versus other races.

Conclusions: In our analysis, approximately 25% of individuals with stage 3-5 CKD in the USA had anaemia and approximately 2% had anaemia eligible for ESA treatment.

Keywords: National Health and Nutrition Examination Survey; anaemia; chronic kidney disease; prevalence.

Graphical Abstract

Figure 1:

Mean (95% CI) Hb levels in participants with stage 3–5 CKD by NHANES release year from 1999–2018.

Figure 2:

Weighted prevalence (95% CI) of anaemia and Hb <10 g/dL in participants with stage 3–5 CKD by NHANES release year from 1999–2018. ^aDefined as Hb <12 g/dL in women and <13 g/dL in men.

Figure 3:

Weighted prevalence (95% CI) of anaemia and Hb <10 g/dL (left y-axis) and mean (95% CI) Hb levels (right y-axis) by CKD stage using pooled NHANES data from 1999–2018. ^aDefined as Hb <12 g/dL in women and <13 g/dL in men.

Figure 4:

Multivariate logistic regression analysis of patient characteristics associated with prevalence of (A) anaemia (defined as Hb <12 g/dL in women and <13 g/dL in men) and (B) Hb <10 g/dL in participants with stage 3–5 CKD using pooled NHANES data from 1999 to 2018. ^aUncontrolled hypertension; defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg (with or without the use of antihypertensive medications). BMI, body mass index; NH, non-Hispanic; OR, odds ratio.