Poor recognition and undertreatment of anemia in patients with chronic kidney disease managed in primary care
Anemia is a common complication of chronic kidney disease (CKD), but limited awareness and treatment options may hinder its management among CKD patients followed in primary care. We evaluated adults with CKD stages 3-5 attending primary care in Stockholm, Sweden, 2012-2018. We assessed the incidenc...
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| Veröffentlicht in: | Journal of internal medicine 2023-11, Vol.294 (5), p.628-639 |
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| creator | Xu, Yang Evans, Marie Mazhar, Faizan Ärnlöv, Johan Cockburn, Elinor Barany, Peter Carrero, Juan-Jesus |
| description | Anemia is a common complication of chronic kidney disease (CKD), but limited awareness and treatment options may hinder its management among CKD patients followed in primary care.
We evaluated adults with CKD stages 3-5 attending primary care in Stockholm, Sweden, 2012-2018. We assessed the incidence of anemia, clinical reactions, and association with subsequent major adverse cardiovascular events (MACE) and death.
We identified 45,637 patients with CKD stages 3-5 free from anemia (mean age 78 years; 64% females; 79% CKD stage 3b). During a median follow-up of 2.4 years, 26% of patients developed anemia, and 10.4% developed severe anemia (hemoglobin |
| doi_str_mv | 10.1111/joim.13702 |
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We evaluated adults with CKD stages 3-5 attending primary care in Stockholm, Sweden, 2012-2018. We assessed the incidence of anemia, clinical reactions, and association with subsequent major adverse cardiovascular events (MACE) and death.
We identified 45,637 patients with CKD stages 3-5 free from anemia (mean age 78 years; 64% females; 79% CKD stage 3b). During a median follow-up of 2.4 years, 26% of patients developed anemia, and 10.4% developed severe anemia (hemoglobin <10 g/dL). Within 6 months from the anemia event, iron tests were infrequent; ferritin and transferrin saturation were tested in 27% and 11% of anemia cases, respectively, and 49% and 24% of severe anemia cases. Few patients were recognized with a clinical diagnosis (15% of anemia cases; 68% of severe anemias). Only 19% of patients with anemia received treatment, primarily iron (10%) and blood transfusions (7%); erythropoietin-stimulating agent use was anecdotal (∼1%). Treatment rates for severe anemia were higher, but 43% of patients still failed to receive treatment. Developing anemia was associated with a higher risk of MACE and death.
Anemia was common and associated with adverse outcomes among patients with CKD stages 3-5 managed in primary care. Iron stores were infrequently tested, and a large proportion of patients with anemia remained untreated/under-recognized.</description><identifier>ISSN: 0954-6820</identifier><identifier>ISSN: 1365-2796</identifier><identifier>EISSN: 1365-2796</identifier><identifier>DOI: 10.1111/joim.13702</identifier><identifier>PMID: 37463872</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Anemia ; Blood transfusion ; Erythropoietin ; Ferritin ; Health services ; Hemoglobin ; Iron ; Kidney diseases ; Kidneys ; Medicin och hälsovetenskap ; Patients ; Primary care ; Transferrin</subject><ispartof>Journal of internal medicine, 2023-11, Vol.294 (5), p.628-639</ispartof><rights>2023 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.</rights><rights>2023. This article is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c398t-1cf2057fd01bc42a4f21fb43e147b5b66a6c67a227d520811f42b3f4b620cf6d3</cites><orcidid>0000-0003-4763-2024</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,552,780,784,885,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37463872$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:153393601$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Xu, Yang</creatorcontrib><creatorcontrib>Evans, Marie</creatorcontrib><creatorcontrib>Mazhar, Faizan</creatorcontrib><creatorcontrib>Ärnlöv, Johan</creatorcontrib><creatorcontrib>Cockburn, Elinor</creatorcontrib><creatorcontrib>Barany, Peter</creatorcontrib><creatorcontrib>Carrero, Juan-Jesus</creatorcontrib><title>Poor recognition and undertreatment of anemia in patients with chronic kidney disease managed in primary care</title><title>Journal of internal medicine</title><addtitle>J Intern Med</addtitle><description>Anemia is a common complication of chronic kidney disease (CKD), but limited awareness and treatment options may hinder its management among CKD patients followed in primary care.
We evaluated adults with CKD stages 3-5 attending primary care in Stockholm, Sweden, 2012-2018. We assessed the incidence of anemia, clinical reactions, and association with subsequent major adverse cardiovascular events (MACE) and death.
We identified 45,637 patients with CKD stages 3-5 free from anemia (mean age 78 years; 64% females; 79% CKD stage 3b). During a median follow-up of 2.4 years, 26% of patients developed anemia, and 10.4% developed severe anemia (hemoglobin <10 g/dL). Within 6 months from the anemia event, iron tests were infrequent; ferritin and transferrin saturation were tested in 27% and 11% of anemia cases, respectively, and 49% and 24% of severe anemia cases. Few patients were recognized with a clinical diagnosis (15% of anemia cases; 68% of severe anemias). Only 19% of patients with anemia received treatment, primarily iron (10%) and blood transfusions (7%); erythropoietin-stimulating agent use was anecdotal (∼1%). Treatment rates for severe anemia were higher, but 43% of patients still failed to receive treatment. Developing anemia was associated with a higher risk of MACE and death.
Anemia was common and associated with adverse outcomes among patients with CKD stages 3-5 managed in primary care. Iron stores were infrequently tested, and a large proportion of patients with anemia remained untreated/under-recognized.</description><subject>Anemia</subject><subject>Blood transfusion</subject><subject>Erythropoietin</subject><subject>Ferritin</subject><subject>Health services</subject><subject>Hemoglobin</subject><subject>Iron</subject><subject>Kidney diseases</subject><subject>Kidneys</subject><subject>Medicin och hälsovetenskap</subject><subject>Patients</subject><subject>Primary care</subject><subject>Transferrin</subject><issn>0954-6820</issn><issn>1365-2796</issn><issn>1365-2796</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>D8T</sourceid><recordid>eNp1kU9r3DAQxUVpaTbbXvoBiqCXEnAqaWTJPpbQfxBoDunZyNIo0WYtbSWbkG9fJbtJIRBdRjx-bxjeI-QDZ6e8vi-bFKZTDpqJV2TFQbWN0L16TVasb2WjOsGOyHEpG8Y4MMXekiPQUkGnxYpMFyllmtGmqxjmkCI10dElOsxzRjNPGGeafFVxCoaGSHdmDlUs9DbM19Re5xSDpTfBRbyjLhQ0BelkorlC98DnMJl8R63J-I688WZb8P1hrsmf798uz342579__Dr7et5Y6Lu54dYL1mrvGB-tFEZ6wf0oAbnUYzsqZZRV2gihXStYx7mXYgQvRyWY9crBmjT7veUWd8s4HG4YkgnDQbqpPxykbAG6yvcv8ruc3H_To5FXXw-qJromn_feCv5dsMzDFIrF7bZGlpYyiA56Db0AqOinZ-gmLTnWJCqlW1DABavUyZ6yOZWS0T-dw9lwX_hwX_jwUHiFPx5WLuOE7gl9bBj-AekFqHM</recordid><startdate>20231101</startdate><enddate>20231101</enddate><creator>Xu, Yang</creator><creator>Evans, Marie</creator><creator>Mazhar, Faizan</creator><creator>Ärnlöv, Johan</creator><creator>Cockburn, Elinor</creator><creator>Barany, Peter</creator><creator>Carrero, Juan-Jesus</creator><general>Blackwell Publishing Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>C1K</scope><scope>K9.</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0003-4763-2024</orcidid></search><sort><creationdate>20231101</creationdate><title>Poor recognition and undertreatment of anemia in patients with chronic kidney disease managed in primary care</title><author>Xu, Yang ; Evans, Marie ; Mazhar, Faizan ; Ärnlöv, Johan ; Cockburn, Elinor ; Barany, Peter ; Carrero, Juan-Jesus</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c398t-1cf2057fd01bc42a4f21fb43e147b5b66a6c67a227d520811f42b3f4b620cf6d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Anemia</topic><topic>Blood transfusion</topic><topic>Erythropoietin</topic><topic>Ferritin</topic><topic>Health services</topic><topic>Hemoglobin</topic><topic>Iron</topic><topic>Kidney diseases</topic><topic>Kidneys</topic><topic>Medicin och hälsovetenskap</topic><topic>Patients</topic><topic>Primary care</topic><topic>Transferrin</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Xu, Yang</creatorcontrib><creatorcontrib>Evans, Marie</creatorcontrib><creatorcontrib>Mazhar, Faizan</creatorcontrib><creatorcontrib>Ärnlöv, Johan</creatorcontrib><creatorcontrib>Cockburn, Elinor</creatorcontrib><creatorcontrib>Barany, Peter</creatorcontrib><creatorcontrib>Carrero, Juan-Jesus</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SwePub Articles full text</collection><jtitle>Journal of internal medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Xu, Yang</au><au>Evans, Marie</au><au>Mazhar, Faizan</au><au>Ärnlöv, Johan</au><au>Cockburn, Elinor</au><au>Barany, Peter</au><au>Carrero, Juan-Jesus</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Poor recognition and undertreatment of anemia in patients with chronic kidney disease managed in primary care</atitle><jtitle>Journal of internal medicine</jtitle><addtitle>J Intern Med</addtitle><date>2023-11-01</date><risdate>2023</risdate><volume>294</volume><issue>5</issue><spage>628</spage><epage>639</epage><pages>628-639</pages><issn>0954-6820</issn><issn>1365-2796</issn><eissn>1365-2796</eissn><abstract>Anemia is a common complication of chronic kidney disease (CKD), but limited awareness and treatment options may hinder its management among CKD patients followed in primary care.
We evaluated adults with CKD stages 3-5 attending primary care in Stockholm, Sweden, 2012-2018. We assessed the incidence of anemia, clinical reactions, and association with subsequent major adverse cardiovascular events (MACE) and death.
We identified 45,637 patients with CKD stages 3-5 free from anemia (mean age 78 years; 64% females; 79% CKD stage 3b). During a median follow-up of 2.4 years, 26% of patients developed anemia, and 10.4% developed severe anemia (hemoglobin <10 g/dL). Within 6 months from the anemia event, iron tests were infrequent; ferritin and transferrin saturation were tested in 27% and 11% of anemia cases, respectively, and 49% and 24% of severe anemia cases. Few patients were recognized with a clinical diagnosis (15% of anemia cases; 68% of severe anemias). Only 19% of patients with anemia received treatment, primarily iron (10%) and blood transfusions (7%); erythropoietin-stimulating agent use was anecdotal (∼1%). Treatment rates for severe anemia were higher, but 43% of patients still failed to receive treatment. Developing anemia was associated with a higher risk of MACE and death.
Anemia was common and associated with adverse outcomes among patients with CKD stages 3-5 managed in primary care. Iron stores were infrequently tested, and a large proportion of patients with anemia remained untreated/under-recognized.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>37463872</pmid><doi>10.1111/joim.13702</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0003-4763-2024</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Anemia Blood transfusion Erythropoietin Ferritin Health services Hemoglobin Iron Kidney diseases Kidneys Medicin och hälsovetenskap Patients Primary care Transferrin |
| title | Poor recognition and undertreatment of anemia in patients with chronic kidney disease managed in primary care |
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