Poor recognition and undertreatment of anemia in patients with chronic kidney disease managed in primary care.

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Recommended citation: Xu Y*, Evans M, Mazhar F, et al.(2023). "Poor recognition and undertreatment of anemia in patients with chronic kidney disease managed in primary care." Journal of Internal Medicine. 2023;00:1-12.
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