A retrospective database analysis of erythropoiesis‐stimulating agent treatment patterns and associated healthcare resource use in patients with non–dialysis‐dependent chronic kidney disease–related anaemia in Japan

Abstract

Aim: This study was conducted to evaluate clinical characteristics, treatment patterns, and healthcare resource use (HCRU) for patients in Japan with non-dialysis-dependent chronic kidney disease (CKD) and anaemia. Methods: This retrospective, longitudinal, epidemiological database extraction study used the JMDC Claims Database, comprising 9.4 million unique beneficiaries. The observation period for anaemia and erythropoiesis-stimulating agent (ESA)/iron treatment was 1 January 2015 to 31 December 2018, and for HCRU and costs was 1 April 2016 to 31 March 2018. The non-dialysis-dependent CKD anaemia population, and the ESA treatment, iron treatment, and no-treatment cohorts were evaluated. Patient characteristics, treatment patterns, and outcomes were summarised descriptively. Results:The non-dialysis-dependent CKD anaemia population included 5908 patients (7.9%), with 464 patients in the ESA treatment cohort, 809 patients (13.7%) in the iron treatment cohort (13.7%), and 4405 (74.6%) patients in the no-treatment cohort. The prevalence of patients prescribed an antihypertensive, antidiabetic, and/or antihyperlipidaemic medication generally increased with increasing baseline CKD stage. Proportions of no treatment for anaemia decreased while ESA treatment increased with increasing CKD stage;ESA treatment increased with decreasing baseline haemoglobin levels. Patients in the ESA treatment cohort generally had more frequent events associated with HCRU and higher costs from HCRU-associated activities (e.g., inpatient and outpatient care, pharmacy). Conclusion:As CKD severity increased, anaemia management changed from iron use or no treatment to ESA use; however, anaemia may be undertreated across all CKD stages. ESA-treated patients incurred greater HCRU-associated costs relative to other patients with non-dialysis-dependent CKD anaemia in Japan.

Physician and Patient Preferences for Treatment of Anemia Associated with Chronic Kidney Disease in Japan: A Survey Including Best-Worst Scaling

“…17 Our findings are also confirmed by a database study using records from the JMDC Claims Database, which reported that only 15% of patients with anemia of NDD-CKD (defined using Japanese Society for Dialysis Therapy guidelines) were treated for anemia. 14 Similarly, a study of records from the Japan Chronic Kidney Disease Database showed that over three-quarters of patients with CKD stages G4 or G5 and Hb level ≤11.0 g/dL were not receiving ESA treatment. 4 However, a paper by Okamoto et al indicates that ESA treatment may differ widely by specialty: 77.3% of patients with anemia of CKD (Hb level ≤11.0 g/dL) and under the care of a nephrologist were prescribed ESAs, but less than one-third of patients with anemia of CKD in other clinical departments were prescribed ESAs.…”

“…7 , 9 , 13 Currently in Japan, the most commonly used treatments are oral iron therapy in the early stages of CKD and ESAs during the later stages. 14 Intravenous (IV) iron therapy is sparingly used across all CKD stages, and blood transfusion is given mostly to hospitalized patients. 15 However, each of these therapies has its limitations.…”

“…7 IV iron is more efficacious than oral iron, but requires IV access and is associated with infrequent but severe adverse events. 7 Moreover, although iron therapy is considerably cheaper than ESAs, 14 ESAs are required to address a second mechanism underlying anemia of CKD, namely deficiencies in endogenous erythropoietin production. 7 , 16 A notable disadvantage of ESAs is the requirement for either subcutaneous or IV administration, which can be painful and inconvenient for the patient, and/or necessitate hospital visits in the case of IV administration.…”

Involuntary Falls in Patients with Chronic Kidney Diseases on Nephrology Wards: Research Advances and Future Perspectives

“…50,51 Fifth, malnutrition can impact the production and function of red blood cells. 52 Therefore, recognizing and addressing anemia with alacrity is paramount for CKD patients. Treatment options for anemia include EPO replacement therapy, iron supplementation, and red blood cell transfusion.…”