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Prescription rate of erythropoietin-stimulating agents is low for patients with renal impairment under non-nephrology care in a tertiary-level academic medical center in Japan

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Abstract

Background

Erythropoiesis-stimulating agents (ESAs) and iron supplements may be prescribed appropriately under nephrology care. However, there are few reports detailing the differences in prescription rates of these therapies among clinical departments.

Methods

A total of 39,585 patients with renal impairment were enrolled from a database of 914,280 patients. Patients were selected based on an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m2. There were eight clinical departments from internal medicine, including nephrology. We defined a hemoglobin level less than 11.0 g/dL as anemia and set 20% of transferrin saturation and 100 ng/mL of serum ferritin as cutoff points. We compared the prescription rates of ESAs and iron supplementation based on the hemoglobin level and iron status among the patients seen across the eight clinical departments.

Results

The lower the eGFR, the more the number of patients seen under nephrology care. The rates of patients with no prescription were 52.3, 39.9, 45.9, and 54.3% among those with hemoglobin levels of < 8, 8 ≤  < 9, 9 ≤  < 10, and 10 ≤  < 11 g/dL, respectively. Of the patients with less than 11.0 g/dL of hemoglobin, 77.3% were prescribed ESAs under nephrology care. Meanwhile, only 18.5 and 8.2% of patients were prescribed ESAs in clinical departments of internal medicine, other than nephrology, and non-internal medicine care, respectively.

Conclusion

Treatment for anemia has not been sufficiently performed in patients with renal impairment under non-nephrology care in a real-world clinical setting.

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Funding

This study was supported by research funds with no restrictions on publication from Kyowa Kirin Co., Ltd. IBM Research provided support for this study in the form of salaries for A. Koseki, T. Iwamori, and M. Kudo. There are no patents, products in development, or marketed products associated with this research.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya, Aichi, 4548509, Japan

    Naoki Okamoto & Daijo Inaguma

  2. Department of Nephrology, Fujita Health University, Toyoake, Japan

    Hiroki Hayashi & Yukio Yuzawa

  3. IBM Research, Tokyo, Japan

    Akira Koseki, Toshiya Iwamori & Michiharu Kudo

Authors
  1. Naoki Okamoto
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  2. Daijo Inaguma
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  3. Hiroki Hayashi
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  4. Akira Koseki
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  5. Toshiya Iwamori
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  6. Michiharu Kudo
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  7. Yukio Yuzawa
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Contributions

DI, NO and HH were involved in the study design and data interpretation. NO and DI contributed to writing the manuscript. AK, TI and MK analyzed the data. YY overviewed and criticized the manuscript. All authors were involved in drafting, reviewing, and approving the final manuscript.

Corresponding author

Correspondence to Daijo Inaguma.

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Conflict of interest

Honoraria (lecture fee): D. Inaguma received lecture fees from Kyowa Kirin Co., Ltd., Torii Pharmaceutical Co., Ltd., Kissei Pharmaceutical Co., Ltd., and Ono Pharmaceutical Co., Ltd. H Hayashi received a lecture fee from Otsuka Pharmaceutical Co., Ltd. Grants received: D. Inaguma received research funding from Sanwa Kagaku Kenkyusho Co., Ltd. Y. Yuzawa received research grants from Otsuka Pharmaceutical Co., Ltd., Kyowa Kirin Co., Ltd.

Ethical approval

The present study was conducted in accordance with the Ethical guidelines for Clinical Research by the Japanese Ministry of Health, Labor, and Welfare (created July 30, 2003; full revision December 28, 2004; full revision July 31, 2008) and the Helsinki Declaration (revised 2013). This study was approved by the clinical research ethics committee at Fujita Health University School of Medicine (approval number: HM19-157). All data were fully anonymized before the analysis.

Informed consent

The contents of the entire research have been displayed in the information disclosure document on the Web, and informed consent was obtained in the form of an opt-out on the website. Those who were rejected were excluded. The trial registration number of the study was UMIN 000037476, and it was registered on August 1, 2019.

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Supplementary Information

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10157_2022_2194_MOESM1_ESM.tif

Supplementary file1 (TIF 775 KB) Management for anemia in patients with less than 11.0 g/dL of hemoglobin by clinical departments stratified by comorbidity of diabetes A: number of patients (non-diabetes patients), B: rate of patients (non-diabetes patients) C: number of patients (diabetes patients), D: rate of patients (diabetes patients) *Department of internal medicine except for Nephrology (indicated within the dotted box) IM; internal medicine

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Okamoto, N., Inaguma, D., Hayashi, H. et al. Prescription rate of erythropoietin-stimulating agents is low for patients with renal impairment under non-nephrology care in a tertiary-level academic medical center in Japan. Clin Exp Nephrol 26, 678–687 (2022). https://doi.org/10.1007/s10157-022-02194-0

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  • DOI: https://doi.org/10.1007/s10157-022-02194-0

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