Undertreatment of Anemia in Patients with Chronic Kidney Disease in the United States: Analysis of National Outpatient Survey Data

Rasu, Rafia S.; Manley, Harold J.; Crawford, Tonya; Balkrishnan, Rajesh

doi:10.1016/j.clinthera.2007.07.016

Cited by 17 publications

(13 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For those with anemia of CKD, less than 10% were receiving an ESP (see Table 3). The trends from the present study are consistent with prior research with NH residents Narayanan et al, 2005), and with reported CKD treatment rates among community-dwelling older adults in the United States (the majority of whom are more than 65 years of age; Maddux et al, 2007;Rasu, Manley, Crawford, & Balkrishnan, 2007). Possible reasons for lack of ESP treatment among NH residents may include refusal of treatment, cost concerns, and provider belief in the risk-benefit ratio of treatment in light of the current U.S. Food and Drug Administration (FDA) black box warning that advises safety and caution for potentially adverse cardiovascular and mortality outcomes observed at higher Hgb levels (FDA, 2009;NKF, 2007;Strippoli, Craig, Manno, & Schena, 2004).…”

Section: Discussionsupporting

confidence: 92%

Anemia Evaluation and Management in Nursing Home Residents

et al. 2010

View full text Add to dashboard Cite

Anemia is often an unrecognized and/or undertreated diagnosis in older adults. Failure to diagnose anemia leads to delayed treatment and thus delayed relief of symptoms. Given the potentially significant impact of anemia on cardiovascular disease and physical performance among older nursing home (NH) residents, it is important to evaluate current clinical practice related to anemia.The purpose of this secondary data analysis was to evaluate the frequency of laboratory evaluation and medication treatment for anemia among older NH residents. Results indicated that more than half of NH residents were anemic at baseline, and of those, less than 20% had additional testing done to further evaluate for an underlying cause of their anemia and only 45.3% received any pharmacologic treatment. Future research is needed to clarify the potential benefits of timely diagnosis and appropriate treatment for anemic older adults in long-term-care settings and establish evidence-based guidelines to direct care in this area.

show abstract

Section: Discussionsupporting

confidence: 92%

Anemia Evaluation and Management in Nursing Home Residents

et al. 2010

View full text Add to dashboard Cite

show abstract

“…Reported treatment rates are typically low (10–15%), regardless of the source of data. In an analysis of the National Ambulatory Medical Care Survey (1996–2002), just 10% of outpatient visits for anemia management in CKD resulted in prescription of medication for anemia [26]. In an online survey conducted in 2006, just 15% of 376 family medicine and internal medicine trainees in the United States reported that they would initiate treatment for anemia in CKD at hemoglobin levels <11 g/dL [27].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Anemia in Chronic Kidney Disease in the United States

Stauffer¹,

2014

View full text Add to dashboard Cite

Anemia is one of the many complications of chronic kidney disease (CKD). However, the current prevalence of anemia in CKD patients in the United States is not known. Data from the National Health and Nutrition Examination Survey (NHANES) in 2007–2008 and 2009–2010 were used to determine the prevalence of anemia in subjects with CKD. The analysis was limited to adults aged >18 who participated in both the interview and exam components of the survey. Three outcomes were assessed: the prevalence of CKD, the prevalence of anemia in subjects with CKD, and the self-reported treatment of anemia. CKD was classified into 5 stages based on the glomerular filtration rate and evidence of kidney damage, in accordance with the guidelines of the National Kidney Foundation. Anemia was defined as serum hemoglobin levels ≤12 g/dL in women and ≤13 g/dL in men. We found that an estimated 14.0% of the US adult population had CKD in 2007–2010. Anemia was twice as prevalent in people with CKD (15.4%) as in the general population (7.6%). The prevalence of anemia increased with stage of CKD, from 8.4% at stage 1 to 53.4% at stage 5. A total of 22.8% of CKD patients with anemia reported being treated for anemia within the previous 3 months–14.6% of patients at CKD stages 1–2 and 26.4% of patients at stages 3–4. These results update our knowledge of the prevalence and treatment of anemia in CKD in the United States.

show abstract

“…This observation can be the consequence of the lack of epoetin (EPO) treatment or individual Hb fluctuations or both. Indeed, on the one hand, omission of therapy with EPO is frequent throughout the whole spectrum of CKD (3)(4)(5)(6)(7)(8)(11)(12)(13)(14)(15)(16); on the other hand, several studies have reported that in treated patients, transitory reductions of Hb levels below target range are common and associated with worse outcome (17)(18)(19)(20)(21)(22). Specifically, in nondialysis patients with CKD, we found that intrapatient Hb variability occurred frequently, with most patients showing a limited extent of time spent with Hb at target (time in target), and that short time in target is associated with lower renal survival (21).…”

mentioning

confidence: 99%

Epoetin Therapy and Hemoglobin Level Variability in Nondialysis Patients with Chronic Kidney Disease

Minutolo

Chiodini

Cianciaruso

et al. 2009

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and objectives: Intrapatient variability of hemoglobin (Hb) is a newly proposed determinant of adverse outcome in chronic kidney disease (CKD). We evaluated whether intensity of epoetin therapy affects Hb variability and renal survival in nondialysis CKD.Design, setting, participants, & measurements: We calculated the individual therapeutic index (TI) for epoetin (EPO; difference between rates of visits that required EPO dosage change and those with effective EPO change) from 1198 visits during the first year of EPO in 137 patients. Renal death was registered in the subsequent 18.1 mo. Analysis was made by TI tertile (lower, middle, and higher; i.e., from more to less intensive therapy).Results

show abstract

Undertreatment of Anemia in Patients with Chronic Kidney Disease in the United States: Analysis of National Outpatient Survey Data

Cited by 17 publications

References 10 publications

Anemia Evaluation and Management in Nursing Home Residents

Anemia Evaluation and Management in Nursing Home Residents

Prevalence of Anemia in Chronic Kidney Disease in the United States

Epoetin Therapy and Hemoglobin Level Variability in Nondialysis Patients with Chronic Kidney Disease

Contact Info

Product

Resources

About