Delayed Anemia Treatment Ups Cardiovascular Events Risks in CKD – Renal and Urology News

Delaying renal anemia treatment with long-acting erythropoiesis-stimulating agents (ESAs) until hemoglobin levels fall below 9.0 g/dL increases the risks for cardiovascular events among patients with anemia and nondialysis-dependent chronic kidney disease (NDD-CKD), according to an analysis of Japanese patients with renal anemia using real-world databases.

The study population included 1472 patients in the Medical Data Vision (MDV) database and 1264 in the Real World Data (RWD) database. Investigators categorized patients into early treatment groups (hemoglobin levels of 9.0 g/dL or higher) and delayed treatment groups (hemoglobin levels less than 9.0 g/dL). Long-acting ESAs included darbepoetin alfa or continuous erythropoietin receptor activator (CERA).

In propensity-score matched analyses, delayed vs early anemia treatment was significantly associated with 47% and 34% increased risks of a cardiovascular composite outcome including hospitalization for ischemic heart disease, myocardial infarction, stroke, heart failure, or cardiovascular death in the MDV and RWD cohorts, respectively, Kouji Kawai, MD, of Mitsubishi Tanabe Pharma Corporation in Tokyo, Japan, and colleagues reported in Kidney International Reports. Delayed anemia treatment also was significantly associated with a 50% and 53% increased risk for heart failure alone and an 83% and 64% increased risk for all-cause mortality, respectively.

Delaying anemia treatment did not appear to affect the risk for the primary renal composite outcome, including renal replacement therapy, a 50% or more decline in estimated glomerular filtration rate (eGFR), progression to an eGFR less than 6.0 mL/min/1.73 m², or all-cause mortality, the investigators reported.

According to Dr Kawai’s team, “earlier intervention than current practice for anemia in NDD-CKD may be desirable to avoid cardiovascular events and mortality in these patients.”

Among the study’s limitations, the investigators were not able to adjust for comorbidity severity, transferrin saturation, or C-reactive protein levels.

Disclosure: This research was supported by the Mitsubishi Tanabe Pharma Corporation. Please see the original reference for a full list of disclosures.