Epidemiología y tratamiento de la anemia renal en España: estudio retrospectivo RIKAS / Epidemiology and treatment of renal anaemia in Spain: RIKAS retrospective study

Antecedentes y objetivo: Los estudios sobre la prevalencia de anemia en enfermedad renal crónica (ERC) en adultos no en diálisis (ERC-ND) y en programa de diálisis (ERC-D) en España no son recientes, o se centran en ciertos subgrupos. El objetivo fue conocer la epidemiología y los patrones actuales de tratamiento de la anemia asociada a la ERC en España. Materiales y métodos: Estudio multicéntrico, no intervencionista, retrospectivo con pacientes ERC-ND estadios 3a-5 y ERC-D, atendidos en España entre 2015 y 2017 (estudio RIKAS). Resultados: La prevalencia de anemia en ERC-ND y ERC-D en 2015 fue del 33,8 y del 91,5%, respectivamente, con resultados similares durante 2016-2017. La prevalencia de inflamación sistémica en pacientes anémicos (18,1 y 51,8% para ERC-ND y ERC-D, respectivamente) fue superior, especialmente en aquellos tratados con agentes estimuladores de eritropoyesis (AEE), respecto a la población general con ERC-ND. Tras 12meses de seguimiento, los valores medios de ferritina y del índice de saturación de transferrina (IST) en pacientes anémicos con ERC-ND fueron de 187,1ng/ml y del 22,2%, respectivamente, mientras que en ERC-D fueron de 254,6ng/ml y del 20,2%. En pacientes tratados con AEE, los valores medios fueron de 190,6ng/ml y del 22,0% en ERC-ND, y de 255,0ng/ml y del 20,2% en ERC-D. Conclusiones: La prevalencia de anemia y de inflamación aumentan con la severidad de la enfermedad, siendo mayores en ERC-D. Los parámetros férricos en pacientes anémicos tratados o no con AEE son insuficientes según las guías, por lo que existe un margen de mejora para el tratamiento de la anemia asociada a la ERC. (AU)

Background and objective: Studies on the prevalence of anaemia in chronic kidney disease (CKD) in adults not on dialysis (CKD-ND) and in dialysis programmes (CKD-D) in Spain are not recent or focus on certain subgroups. The aim of this study was to know the epidemiology and current treatment patterns of anaemia associated with CKD in Spain. Materials and methods: Multicentre, non-interventional, retrospective study with CKD-ND stage 3a-5 and CKD-D patients treated in Spain between 2015 and 2017 (RIKAS study). Results: The prevalence of anaemia in CKD-ND and CKD-D in 2015 was 33.8% and 91.5%, respectively, with similar results during 2016-2017. The prevalence of systemic inflammation in anaemic patients (18.1% and 51.8% for CKD-ND and CKD-D, respectively) was higher, especially in those treated with erythropoiesis-stimulating agents (ESA), compared to the general population with CKD-ND. After 12months of follow-up, mean ferritin and transferrin saturation index (TSI) values in anaemic patients with CKD-ND were 187.1ng/ml and 22.2%, respectively, while in CKD-D were 254.6ng/ml and 20.2%. In ESA-treated patients, mean values were 190.6ng/ml and 22.0% in ND-CKD, and 255.0ng/ml and 20.2% in D-CKD. Conclusions: The prevalence of anaemia and inflammation increased with disease severity, being higher in D-CKD. Iron parameters in anaemic patients treated or not with ESA are insufficient according to the guidelines, so there is room for improvement in the treatment of anaemia associated with CKD. (AU)

Real-Life Anemia Management Among Patients with Non-Dialysis-Dependent Chronic Kidney Disease in Three European Countries.

Background: Anemia is prevalent among patients with chronic kidney disease (CKD), yet current evidence indicates that treatment may not adhere to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. We aimed to document the management of patients with non-dialysis-dependent (NDD)-CKD receiving erythropoiesis-stimulating agent (ESA) therapy in Europe. Methods: This retrospective, observational study extracted information from medical records in Germany, Spain, and the UK. Eligible patients were adults with NDD-CKD stages 3b-5 who initiated ESA therapy for anemia between January and December 2015. Anemia was defined as hemoglobin (Hb) <13.0 g/dL (males) or <12.0 g/dL (females). Data regarding ESA treatment, treatment response, concomitant iron therapy and blood transfusions were extracted up to 24 months post-ESA initiation, and data on CKD progression until abstraction date. Results: Eight hundred and forty-eight medical records were abstracted. Approximately 40% received no iron therapy prior to ESA initiation. At ESA initiation, mean ± standard deviation Hb level was 9.8 ± 1.0 g/dL. Most patients received darbepoetin alfa, and switching between ESAs was rare (8.5% of patients). Concomitant intravenous and oral iron therapy was prescribed for 36% and 42% of patients, respectively, during initial ESA therapy. Mean Hb levels reached the target level (10-12 g/dL) within 3-6 months of ESA initiation. Hb, transferrin saturation, and ferritin levels were infrequently monitored from 3 months post-ESA initiation. Rates of blood transfusion, dialysis, and diagnosis of end-stage renal disease were 16.4%, 19.3%, and 24.6%, respectively. Rates of kidney transplant and death were 4.8% and 8.8%, respectively. Conclusion: Among ESA-treated patients, ESA initiation was in accordance with KDIGO guidelines, but subsequent monitoring of Hb and iron deficiency were suboptimal.