Transfusion burden in non-dialysis chronic kidney disease patients with persistent anemia treated in routine clinical practice: a retrospective observational study
1 Strategic Healthcare Solutions, LLC, P.O. Box 543, Monkton, MD 21111, USA
2 Division of Nephrology and Hypertension, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA
3 Global Health Economics, Amgen, Inc., 1 Amgen Center Drive, Thousand Oaks, CA 91320, USA
4 College of Pharmacy, University of Iowa, 115 S. Grand Avenue, Iowa City, IA 52242, USA
5 Clinical Research, Amgen, Inc., 1 Amgen Center Drive, Thousand Oaks, CA 91320, USA
6 Josephine Ford Cancer Center, Henry Ford Health System, 1 Ford Place Center, Detroit, MI 48202, USA
BMC Nephrology 2012, 13:5 doi:10.1186/1471-2369-13-5Published: 24 January 2012
Transfusion patterns are not well characterized in non-dialysis (ND) chronic kidney disease (CKD) patients. This study describes the proportion of patients transfused, units of blood transfused and trigger-hemoglobin (Hb) levels for transfusions in severe anemic, ND-CKD patients in routine practice.
A retrospective cohort study of electronic medical record data from the Henry Ford Health System identified 374 adult, ND-CKD patients with severe anemia (Hb < 10 g/dL and subsequent use of erythropoiesis-stimulating agents [ESA] therapy, blood transfusions, or a second Hb < 10 g/dL) between January 2004 and June 2008. Exclusions included those with prior diagnoses of cancer, renal or liver transplant, end-stage renal disease, acute bleeding, trauma, sickle cell disease, or aplastic anemia. A gap of ≥ 1 days between units of blood transfused was counted as a separate transfusion.
At least 1 transfusion (mean of 2 units; range, 1-4) was administered to 20% (75/374) of ND-CKD patients with mean (± SD) follow-up of 459 (± 427) days. The mean (± SD) Hb level closest and prior to a transfusion was 8.8 (± 1.5) g/dL. Patients who were hospitalized in the 6 months prior to their first anemia diagnosis were 6.3 times more likely to receive a blood transfusion than patients who were not hospitalized (p < 0.0001). Patients with peripheral vascular disease (PVD) were twice as likely to have a transfusion as patients without PVD (p = 0.04).
Transfusions were prevalent and the trigger hemoglobin concentration was approximately 9 g/dL among ND-CKD patients with anemia. To reduce the transfusion burden, clinicians should consider other anemia treatments including ESA therapy.