Anaemia management in non-dialysis chronic kidney disease (CKD) patients: a multicentre prospective study in renal clinics

Knowledge on anaemia management in non-dialysis chronic kidney disease (ND-CKD) patients regularly followed in renal clinics is scarce although being essential to identifying areas of therapeutic improvement. We prospectively evaluated anaemia management in two visits, performed 6 months apart, in 755 prevalent ND-CKD stage 3b-5 patients followed in 19 nephrology clinics from 6 months. Anaemia was defined as severe (Hb 11 g/dL) or mild (Hb: 1113.5 in males and 1112 g/dL in females); iron deficiency (ID) was defined as transferrin saturation (TSAT) 20 and/or ferritin 100 ng/mL. Primary endpoint was the change of anaemia and ID prevalence between baseline and 6-month visit. Secondary endpoint was the prevalence of clinical inertia to either ESA or iron supplementation, that is, the lack of ESA or iron prescription despite Hb 11 g/dL or ID. Age was 69 13 years and GFR 27.5 10.0 mL/min/1.73 m(2); male gender, diabetes and prior cardiovascular disease were 57.2, 30.1 and 30.1, respectively. Prevalence of severe and mild anaemia was 18.0 and 44.0 at baseline and remained unchanged at Month 6 (19.3 and 43.2). ID was prevalent at both visits (60.1 and 60.9). Clinical inertia to ESA was similar at baseline and at Month 6 (39.6 and 34.2, respectively, P 0.487) and it was less frequent than clinical inertia to iron therapy (75.7 and 72.0, respectively). This study shows that anaemia prevalence is unexpectedly high in the setting of tertiary nephrology care. This was due to a persistent clinical inertia in the anaemia management, remarkable for iron supplementation and less critical, but still significant, for ESA treatment.