Date Published: April 19, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Avani D. Joshi, David A. Holdford, Donald F. Brophy, Spencer E. Harpe, Darcy Mays, Todd W. B. Gehr.
Intravenous (IV) iron and Erythropoiesis Stimulating Agents (ESAs) are recommended for anemia management in chronic kidney disease (CKD). This retrospective cohort study analyzed utilization patterns of IV iron and ESA in patients over 18 years of age admitted to University Health System Hospitals with a primary or secondary diagnosis of CKD between January 1, 2006 to December 31, 2008. A clustered binomial logistic regression using the GEE methodology was used to identify predictors of IV iron utilization. Only 8% (n = 6678) of CKD patients on ESA therapy received IV iron supplementation in university hospitals. Those receiving iron used significantly less amounts of ESAs. Patient demographics (age, race, primary payer), patient clinical conditions (admission status, severity of illness, dialysis status), and physician specialty were identified as predictors of IV iron use in CKD patients. Use of IV iron with ESAs was low despite recommendations from consensus guidelines. The low treatment rate of IV iron represents a gap in treatment practices and signals an opportunity for healthcare improvement in CKD anemic patients.
In the United States, Chronic kidney disease (CKD) affects approximately 26 million Americans and is the cause of significant morbidity and mortality in 1 of 9 adults . Anemia is a common comorbidity of CKD–prevalent in 47% of patients who are not on dialysis . Anemia of CKD results from underproduction of endogenous erythropoietin by the kidneys . In patients with CKD not requiring dialysis, untreated anemia increases cardiovascular risk, hospitalization , all-cause mortality , and impaired cognitive function , and diminishes health-related quality of life  and exercise capacity [7, 8]. Heightened risk for progression of kidney failure has also been linked to untreated anemia of CKD. Thus, management of anemia in CKD patients is essential [9–11].
In this inquiry, we described the utilization of IV iron and ESA in anemic CKD patients. Of the 82,947 CKD patients on ESA therapy, only 8% (n = 6,678) were on IV iron supplementation. Of those 6678 patients on IV iron, 91% were prescribed iron sucrose, and the rest received iron dextran. Almost 30% of the CKD population was on hemodialysis (n = 25,322).
This inquiry describes the utilization of IV iron and ESA in anemic CKD patients, with a focus on understanding predictors of drug use. Data collected from 62 teaching hospitals between 2006 and 2008 showed an increasing trend in the use of IV iron in anemic CKD patients already on ESA therapy. Use of IV iron supplementation was associated with a significant decrease in the duration of therapy of ESA. Despite this positive finding for supplementing ESA administration with IV iron, only 8% of CKD patients receiving ESAs also received IV iron. Patient demographics (age, race, primary payer), patient clinical conditions (admission status, severity of illness, dialysis status), and physician specialty were identified as predictors of IV iron use in CKD patients.