November 02, 2021
Suboptimal Treatment of Anemia in CKD Non-Dialysis Patients: What Role Will HIF-PH Inhibitors Play?
Authors: Meghan Staudt, Tucker Hurtado, Jennifer Robinson
The purpose of this study was to understand the real-world patient presentation and treatment priorities for CKD non-dialysis patients, focusing on the treatment of anemia of CKD.
Using a HIPAA-compliant, online chart audit tool, nephrologists (n=183) submitted de-identified clinical and non-clinical demographic information for 1,030 non-dialysis patients with CKD (eGFR<60) in Fall 2020. This independent, retrospective patient chart audit collected data beginning at the time of patient referral and concluded with details from the most recent visit.
As CKD progresses so too does the prevalence of anemia, with nearly six-in-ten CKD Stage 5 patients identified by their physicians as having anemia. However, while anemia is a common comorbidity in CKD non-dialysis patients, physicians tend to deprioritize the disease when consulting with these patients in their offices. When asked about topics discussed during their most recent patient visit, anemia falls behind other topics such as hypertension, weight and diet, and quality of life.
Although anemia is less of a priority, more than 60% of patients did have a hemoglobin test ordered at their most recent visit, indicating that physicians are monitoring hemoglobin levels somewhat regularly to help keep track of potential anemia. More than one-half of CKD non-dialysis patients treated with ESAs have a hemoglobin level below 10.0 g/dL; however, the most common reason for non-treatment in patients with levels between 9.0 and 9.9 g/dL is that the hemoglobin is “not low enough”, indicating physicians are waiting until hemoglobin is substantially low before starting treatment with ESAs.
HIF-PH inhibitors are a novel class in development for the treatment of anemia, and nephrologists express a willingness to use the agents in their CKD non-dialysis patients who are not currenlty treated (45% Stage 3, 52% Stage 4 and 60% Stage 5). More than one-half (58%) would also be willing to switch ESA-treated non-dialysis patients to a HIF-PH inhibitor once they are approved, indicating there is a large opportunity for this class to have an impact on the treatment of anemia.
Enhanced communication with non-dialysis patients about anemia, as well as earlier detection and intervention with novel HIF-PH inhibitors, could lead to better anemia outcomes.