Davis J, Suehs B, Xu Y, Patel S, Schilling CG, Bunniran S, Perkins RM, Vuong K. Understanding treatment of severe anemia due to CKD: a descriptive study in non-dialysis Medicare Advantage Prescription Drug plan patients. Poster presented at the 2020 Virtual American Society of Nephrology Kidney Week Conference; October 2020. [abstract] J Am Soc Nephrol. 2020 Oct; 31:135.

BACKGROUND: Chronic kidney disease (CKD) is more common in people over 65 years (38%) than in people aged 45–64 (13%) or 18–44 (7%). Anemia, a common sequela in CKD patients, affects 8-53% and is more prevalent as CKD progresses. These patients are also at greater risk for hospitalizations and emergency department (ED) visits. The objective of this study was to examine patient characteristics, treatment rates, and time to treatment among Medicare Advantage Prescription Drug Plan (MAPD) patients with CKD Stage 3-5 and severe anemia (defined as lab of Hgb <10 g/dL) within a non-dialysis dependent (NDD) cohort.

METHODS: This retrospective cohort study of CKD patients with anemia used Humana claims data (medical, pharmacy, lab) from 2016-2019. The index date was the first anemia diagnosis (Hgb <10 g/dL) date after CKD diagnosis. CKD stage and dialysis independent status were classified in the 12 months pre-index. Treatments [(intravenous (IV) iron, oral iron, erythropoiesis-stimulating agents (ESA), red blood cell transfusions (RBCT)] and all-cause healthcare resource use (HCRU) were examined 12 months post-index.

RESULTS: A total of 31,026 NDD CKD patients with anemia were identified (mean age, 75 years; 60% female). Overall, 36% had an anemia treatment. As the CKD progressed, the percentages of treated patients increased (32%, 39%, and 50% in stage 3, 4, and 5, respectively), ESA use increased (7%, 17%, and 34%), as did IV iron use (11%, 15%, and 21%). RBCT rates (9%) and oral iron use (~13%) stayed consistent across all stages. The median number of days from anemia diagnosis to first anemia treatment was 48 days. As CKD advanced, HCRU increased; in NDD patients with anemia, inpatient admissions in stage 3, 4, and 5, respectively were 46%, 53%, 59% and emergency visits were 64%, 70%, 72% in the 12 months post-index period.

CONCLUSIONS: This descriptive examination of treatment by CKD stage for NDD patients with anemia found that anemia was oftentimes left untreated, especially in the stage 3-4 CKD patients. After NDD CKD patients were diagnosed with anemia, it was almost 1.5 months before treatment was initiated. In NDD CKD patients with anemia, as stage increased, HCRU increased, highlighting the importance of care coordination as CKD progresses.

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