Status of Anemia According to Underlying Renal Disease in Chronic Kidney Disease: The Fukushima CKD Cohort

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  • Tanaka Kenichi
    Department of Nephrology and Hypertension, Fukushima Medical University Department of Chronic Kidney Disease Initiatives, Fukushima Medical University
  • Saito Hirotaka
    Department of Nephrology and Hypertension, Fukushima Medical University
  • Iwasaki Tsuyoshi
    Department of Nephrology and Hypertension, Fukushima Medical University
  • Oda Akira
    Department of Nephrology and Hypertension, Fukushima Medical University
  • Watanabe Shuhei
    Department of Nephrology and Hypertension, Fukushima Medical University
  • Kanno Makoto
    Department of Nephrology and Hypertension, Fukushima Medical University Department of Chronic Kidney Disease Initiatives, Fukushima Medical University
  • Kimura Hiroshi
    Department of Nephrology and Hypertension, Fukushima Medical University
  • Shimabukuro Michio
    Department of Chronic Kidney Disease Initiatives, Fukushima Medical University Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University
  • Asahi Koichi
    Division of Nephrology and Hypertension, Iwate Medical University
  • Watanabe Tsuyoshi
    Department of Chronic Kidney Disease Initiatives, Fukushima Medical University
  • James Kazama Junichiro
    Department of Nephrology and Hypertension, Fukushima Medical University Department of Chronic Kidney Disease Initiatives, Fukushima Medical University

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Abstract

<p>BACKGROUND</p><p>Although anemia is an important factor determining renal and cardiovascular outcomes in patients with chronic kidney disease (CKD), reports on the status of anemia management in Japanese patients with pre-dialysis CKD are limited.</p><p>METHODS</p><p>We retrospectively analyzed CKD patients follow-up at our department between June 2012 and July 2014 (Fukushima CKD cohort study), for the management status of anemia and differences in anemia control under the current treatment strategy, including long-acting erythropoiesis stimulating agents (ESA), classified according to the underlying renal disease, namely primary renal disease, hypertensive nephropathy, diabetic nephropathy, and others. Anemia was defined as a hemoglobin level of <11 g/dL, or receiving ESA therapy.</p><p>RESULTS</p><p>We identified 1,324 patients with CKD, and found that the prevalence of anemia increased with CKD stage, and was significantly higher in diabetic nephropathy than primary renal disease and hypertensive nephropathy (25.3%, 12.9%, and 10.9%, respectively, P <0.001). Anemia was independently related to the underlying renal disease, with a significant difference between diabetic nephropathy and primary renal disease (odds ratio 2.15; 95% confidence interval, 1.16–3.99, P = 0.015). Among those with hemoglobin <11 g/dL, 57.1% of patients were not on ESAs. The mean hemoglobin level was 10.4 ± 1.0 g/dL and achievement rate of a target hemoglobin of ≥11 g/dL, recommended in Japanese guidelines, was 30.1% among subjects on ESA therapy.</p><p>CONCLUSIONS</p><p>These results suggest that intervention for renal anemia is not necessarily adequate among Japanese patients with CKD, even those under nephrologist care, including with use of long-acting ESAs.</p>

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