Outcomes of Early Versus Delayed Anemia Treatment in Nondialysis-Dependent CKD
Introduction: The association of hemoglobin level at treatment initiation with renal and cardiovascular outcomes in patients with anemia in nondialysis-dependent (NDD) chronic kidney disease (CKD) is unclear. Methods: This retrospective cohort study utilized 2 Japanese databases (Medical Data Vision...
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Elsevier
2024-07-01
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| Series: | Kidney International Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S246802492401653X |
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| author | Kouji Kawai Manabu Ishii Yoshimasa Kokado Takashi Horikawa Junichi Hoshino |
| author_facet | Kouji Kawai Manabu Ishii Yoshimasa Kokado Takashi Horikawa Junichi Hoshino |
| author_sort | Kouji Kawai |
| collection | DOAJ |
| description | Introduction: The association of hemoglobin level at treatment initiation with renal and cardiovascular outcomes in patients with anemia in nondialysis-dependent (NDD) chronic kidney disease (CKD) is unclear. Methods: This retrospective cohort study utilized 2 Japanese databases (Medical Data Vision Co. Ltd., Tokyo, Japan [MDV]; and Real World Data Co. Ltd, Kyoto, Japan [RWD]). Patients initiated on long-acting erythropoiesis-stimulating agent (ESA) treatment were divided into early (hemoglobin levels ≥9.0 g/dl) and delayed (<9.0 g/dl) treatment groups. The primary outcome was a renal composite (renal replacement therapy, ≥50% estimated glomerular filtration rate [eGFR] reduction, eGFR <6.0 ml/min per 1.73 m2, and all-cause mortality), and secondary outcomes were a cardiovascular composite (hospitalization by ischemic heart disease, including myocardial infarction, hospitalization by stroke and heart failure, and cardiovascular death) and components of the composite outcomes. Results: After propensity score matching, 1472 (MDV) and 1264 (RWD) patients were evaluated. Delayed treatment was not associated with a risk of the renal composite outcome (MDV: hazard ratio [HR]: 1.15, 95% confidence interval [CI]: 0.99–1.33; RWD: HR: 1.08, 95% CI: 0.92–1.28). However, delayed treatment was associated with higher risks of the cardiovascular composite outcome (MDV: HR: 1.47, 95% CI: 1.16–1.84; RWD: HR: 1.34, 95% CI: 1.09–1.64), heart failure (MDV: HR: 1.50, 95% CI: 1.13–2.00; RWD: HR: 1.53, 95% CI: 1.20–1.96) and all-cause mortality (MDV: HR: 1.83, 95% CI: 1.32–2.54; RWD: HR: 1.64, 95% CI: 1.21–2.22). Conclusion: Although the risk of renal events was not increased following delayed treatment of anemia in patients with NDD-CKD, the risks of cardiovascular events and all-cause mortality were increased, suggesting the importance of early intervention before hemoglobin falls below 9.0 g/dl. |
| format | Article |
| id | doaj-art-2f1e9c85b80d4dddbf04d07e34575967 |
| institution | DOAJ |
| issn | 2468-0249 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | Elsevier |
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| series | Kidney International Reports |
| spelling | doaj-art-2f1e9c85b80d4dddbf04d07e345759672025-08-20T03:21:11ZengElsevierKidney International Reports2468-02492024-07-01972056206610.1016/j.ekir.2024.04.030Outcomes of Early Versus Delayed Anemia Treatment in Nondialysis-Dependent CKDKouji Kawai0Manabu Ishii1Yoshimasa Kokado2Takashi Horikawa3Junichi Hoshino4Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan; Correspondence: Kouji Kawai, Mitsubishi Tanabe Pharma Corporation, 1-1-1 Marunouchi, Chiyoda-ku, Tokyo. Japan.Mitsubishi Tanabe Pharma Corporation, Tokyo, JapanMitsubishi Tanabe Pharma Corporation, Tokyo, JapanMitsubishi Tanabe Pharma Corporation, Tokyo, JapanDepartment of Nephrology, Tokyo Women’s Medical University, Tokyo, JapanIntroduction: The association of hemoglobin level at treatment initiation with renal and cardiovascular outcomes in patients with anemia in nondialysis-dependent (NDD) chronic kidney disease (CKD) is unclear. Methods: This retrospective cohort study utilized 2 Japanese databases (Medical Data Vision Co. Ltd., Tokyo, Japan [MDV]; and Real World Data Co. Ltd, Kyoto, Japan [RWD]). Patients initiated on long-acting erythropoiesis-stimulating agent (ESA) treatment were divided into early (hemoglobin levels ≥9.0 g/dl) and delayed (<9.0 g/dl) treatment groups. The primary outcome was a renal composite (renal replacement therapy, ≥50% estimated glomerular filtration rate [eGFR] reduction, eGFR <6.0 ml/min per 1.73 m2, and all-cause mortality), and secondary outcomes were a cardiovascular composite (hospitalization by ischemic heart disease, including myocardial infarction, hospitalization by stroke and heart failure, and cardiovascular death) and components of the composite outcomes. Results: After propensity score matching, 1472 (MDV) and 1264 (RWD) patients were evaluated. Delayed treatment was not associated with a risk of the renal composite outcome (MDV: hazard ratio [HR]: 1.15, 95% confidence interval [CI]: 0.99–1.33; RWD: HR: 1.08, 95% CI: 0.92–1.28). However, delayed treatment was associated with higher risks of the cardiovascular composite outcome (MDV: HR: 1.47, 95% CI: 1.16–1.84; RWD: HR: 1.34, 95% CI: 1.09–1.64), heart failure (MDV: HR: 1.50, 95% CI: 1.13–2.00; RWD: HR: 1.53, 95% CI: 1.20–1.96) and all-cause mortality (MDV: HR: 1.83, 95% CI: 1.32–2.54; RWD: HR: 1.64, 95% CI: 1.21–2.22). Conclusion: Although the risk of renal events was not increased following delayed treatment of anemia in patients with NDD-CKD, the risks of cardiovascular events and all-cause mortality were increased, suggesting the importance of early intervention before hemoglobin falls below 9.0 g/dl.http://www.sciencedirect.com/science/article/pii/S246802492401653Xanemia in chronic kidney diseasecardiovascular outcomeserythropoiesis-stimulating agentnationwide databasesnondialysis-dependent chronic kidney diseaserenal outcomes |
| spellingShingle | Kouji Kawai Manabu Ishii Yoshimasa Kokado Takashi Horikawa Junichi Hoshino Outcomes of Early Versus Delayed Anemia Treatment in Nondialysis-Dependent CKD Kidney International Reports anemia in chronic kidney disease cardiovascular outcomes erythropoiesis-stimulating agent nationwide databases nondialysis-dependent chronic kidney disease renal outcomes |
| title | Outcomes of Early Versus Delayed Anemia Treatment in Nondialysis-Dependent CKD |
| title_full | Outcomes of Early Versus Delayed Anemia Treatment in Nondialysis-Dependent CKD |
| title_fullStr | Outcomes of Early Versus Delayed Anemia Treatment in Nondialysis-Dependent CKD |
| title_full_unstemmed | Outcomes of Early Versus Delayed Anemia Treatment in Nondialysis-Dependent CKD |
| title_short | Outcomes of Early Versus Delayed Anemia Treatment in Nondialysis-Dependent CKD |
| title_sort | outcomes of early versus delayed anemia treatment in nondialysis dependent ckd |
| topic | anemia in chronic kidney disease cardiovascular outcomes erythropoiesis-stimulating agent nationwide databases nondialysis-dependent chronic kidney disease renal outcomes |
| url | http://www.sciencedirect.com/science/article/pii/S246802492401653X |
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