Open Access Highly Accessed Research article

Transfusion burden in non-dialysis chronic kidney disease patients with persistent anemia treated in routine clinical practice: a retrospective observational study

Kathleen M Fox1*, Jerry Yee2, Ze Cong3, John M Brooks4, Jeffrey Petersen5, Lois Lamerato6 and Shravanthi R Gandra3

Author Affiliations

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

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BMC Nephrology 2012, 13:5  doi:10.1186/1471-2369-13-5

Published: 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.