Abstract
In non-dialysis chronic kidney disease patients, looking for iron deficiency is highly variable in practice and there is a great variability regarding the cutoffs used to treat iron deficiency. The aim of this study is to investigate the degree of iron deficiency in non-dialysis chronic kidney disease patients on erythropoiesis-stimulating agents. We included all non-dialysis chronic kidney disease patients that applied to the Lebanese Ministry of Public Health for erythropoiesis-stimulating agents’ coverage during a 5-month period. Iron requirement was assessed based on two guidelines’ target-to-treat cutoffs: 1-ferritin <100 ng/ml and/or TSAT < 20% (KDOQI 2006), 2- ferritin ≤500 ng/ml and TSAT ≤30% (KDIGO 2012). A total of 238 CKD patients were included over 5 months. All patients had a ferritin level in their record and 64% had an available TSAT. Median age was 71.0 (59.8–79.3) years and 61.8% were female. All had an eGFR<60 ml/min. The proportion of patients found to require iron therapy ranged between 48 and 78% with a trend towards higher values when using KDIGO-based criteria. Using ANCOVA test, inverse normal transformations of ferritin and TSAT showed a reverse pattern between men and women with women being more iron deficient in the early stage. Iron deficiency is highly prevalent in non-dialysis chronic kidney disease patients on erythropoiesis-stimulating agents’ therapy. These findings reflect a lack in effective iron supplementation when managing anemia in pre-dialysis patients, especially in men at advanced stages. Renal societies should spread awareness about iron deficiency screening in those patients.
Highlights
Anemia prevalence worldwide was estimated at 33% in 2010 with iron deficiency being the leading cause in half of the cases [1,2]
We reviewed all applications to the Ministry of Public Health (MOPH) for maintenance erythropoiesis-stimulating agents (ESAs) therapy over 5 months in order to investigate the degree of iron deficiency in ND-chronic kidney disease (CKD) patients on ESA therapy
Missing value analysis taking into account information from all the variables in the dataset did not reject the hypothesis of transferrin saturation (TSAT) as being MCAR (Missing Completely At Random), with Little’s MCAR p-value =
Summary
Anemia prevalence worldwide was estimated at 33% in 2010 with iron deficiency being the leading cause in half of the cases [1,2]. In chronic kidney disease (CKD) patients, anemia is a clinically significant burden and it becomes more prevalent with declining glomerular filtration rate (GFR) [3]. Anemia is associated with reduced quality of life and increased cardiovascular morbidity and mortality [4]. Erythropoietin (EPO) deficiency remains the major cause of anemia in CKD patients due to the decrease in renal EPO production [5].
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