Clinical and Experimental Nephrology

, Volume 15, Issue 2, pp 248–257 | Cite as

Management of anemia in chronic kidney disease patients: baseline findings from Chronic Kidney Disease Japan Cohort Study

  • Tadao Akizawa
  • Hirofumi Makino
  • Seiichi Matsuo
  • Tsuyoshi Watanabe
  • Enyu Imai
  • Kosaku Nitta
  • Yasuo Ohashi
  • Akira Hishida
  • Chronic Kidney Disease Japan Cohort Study Group
Original Article

Abstract

Background

Anemia is a factor that affects the outcome of patients with chronic kidney disease (CKD); however, there are only a few reports on the management of anemia in Japanese patients with CKD who are not on dialysis.

Methods

We investigated the prevalence, related factors and management of anemia in CKD stage 3–5 patients in Japan based on the baseline data obtained from a prospective cohort study (Chronic Kidney Disease Japan Cohort). Anemia was defined as having a hemoglobin (Hb) level of <11 g/dL or receiving erythropoiesis stimulating agent (ESA) therapy.

Results

The result indicated that 946 out of 2,930 patients had anemia. Of these 946 patients, 385 were receiving ESA treatment for anemia and had an Hb level of 10.28 ± 1.19 g/dL (mean ± SD). The percentage of these patients with an Hb level above the target of 11 g/dL proposed for treatment by the Japanese guidelines, and above the maintenance level of 10 g/dL approved for ESA therapy in Japan, was only 30.1 and 61.6%, respectively. In contrast, the percentage of patients receiving no ESA therapy was 67.6 and 55.7%, respectively, among those with an Hb level of <11 and <10 g/dL.

Conclusions

These data suggested that prevalence of anemia was high in Japanese patients with CKD stage 3–5, that the percentage of patients receiving ESA was low among those who required ESA, and that a large number of patients receiving ESA failed to maintain the recommended level of Hb.

Keywords

CKD Erythropoiesis stimulating agent (ESA) Hemoglobin (Hb) Anemia 

Notes

Acknowledgments

This study was conducted by principal investigators at the following medical centers: Sendai Social Insurance Hospital (Miyagi), Toride Kyodo Hospital (Ibaraki), Jichi Medical University (Tochigi), Tokyo Women’s Medical University Hospital (Tokyo), St. Luke’s International Hospital (Tokyo), Showa University Hospital (Tokyo), Showa University Yokohama Northern Hospital (Kanagawa), Showa University Fujigaoka Hospital (Kanagawa), Gifu Prefectural General Medical Center (Gifu), Kasugai Municipal Hospital (Aichi), Tosei General Hospital (Aichi), Osaka University Hospital (Osaka), Osaka General Medical Center (Osaka), Osaka City General Hospital (Osaka), Kurashiki Central Hospital (Okayama), Fukuoka Red Cross Hospital (Fukuoka), Iizuka Hospital (Fukuoka).

References

  1. 1.
    Imai E, Horio M, Watanabe T, Iseki K, Yamagata K, Hara S, et al. Prevalence of chronic kidney disease in the Japanese general population. Clin Exp Nephrol. 2009;13(6):621–30.PubMedCrossRefGoogle Scholar
  2. 2.
    Imai E, Matsuo S, Makino H, Watanabe T, Akizawa T, Nitta K, et al. Chronic Kidney Disease Japan Cohort study: baseline characteristics and factors associated with causative diseases and renal function. Clin Exp Nephrol. 2010;14:558–70.PubMedCrossRefGoogle Scholar
  3. 3.
    Vlagopoulos PT, Tighiouart H, Weiner DE, Griffith J, Pettitt D, Salem DN, et al. Anemia as a risk factor for cardiovascular disease and all-cause mortality in diabetes: the impact of chronic kidney disease. J Am Soc Nephrol. 2005;16:3403–10.PubMedCrossRefGoogle Scholar
  4. 4.
    Al-Ahmad A, Rand WM, Manjunath G, Konstam MA, Salem DN, Levey AS, et al. Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction. J Am Coll Cardiol. 2001;38:955–62.PubMedCrossRefGoogle Scholar
  5. 5.
    Silverberg DS, Wexler D, Sheps D, Blum M, Keren G, Baruch R, et al. The effect of correction of mild anemia in severe, resistant congestive heart failure using subcutaneous erythropoietin and intravenous iron: a randomized controlled study. J Am Coll Cardiol. 2001;37:1775–80.PubMedCrossRefGoogle Scholar
  6. 6.
    Kuriyama S, Tomonari H, Yoshida H, Hashimoto T, Kawaguchi Y, Sakai O. Reversal of anemia by erythropoietin therapy retards the progression of chronic renal failure, especially in nondiabetic patients. Nephron. 1997;77:176–85.PubMedCrossRefGoogle Scholar
  7. 7.
    Gouva C, Nikolopoulos P, Ioannidis JP, Siamopoulos KC. Treating anemia early in renal failure patients slows the decline of renal function: a randomized controlled trial. Kidney Int. 2004;66:753–60.PubMedCrossRefGoogle Scholar
  8. 8.
    Singh AK, Szczech L, Tang KL, Barnhart H, Sapp S, Wolfson M, et al. CHOIR Investigators, correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med. 2006;355:2085–98.PubMedCrossRefGoogle Scholar
  9. 9.
    Drüeke TB, Locatelli F, Clyne N, Eckardt KU, Macdougall IC, Tsakiris D, et al. CREATE Investigators. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med. 2006;355:2071–84.PubMedCrossRefGoogle Scholar
  10. 10.
    National Kidney Foundation. K/DOQI clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease: 2007 Update of Hemoglobin Target. Am J Kidney Dis. 2007;50:471–530.CrossRefGoogle Scholar
  11. 11.
    Locatelli F, Aljama P, Bárány P, Canaud B, Carrera F, Eckardt KU, et al. Revised European Best Practice Guidelines for the management of anaemia in patients with chronic renal failure. Nephrol Dial Transplant. 2004;19(Suppl 2):ii1–47.PubMedCrossRefGoogle Scholar
  12. 12.
    Tsubakihara Y, Nishi S, Akiba T, Hirakata H, Iseki K, Kubota M, et al. 2008 Japanese Society for Dialysis Therapy: guidelines for renal anemia in chronic kidney disease. Ther Apher Dial. 2010;14:240–75.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2011

Authors and Affiliations

  • Tadao Akizawa
    • 1
  • Hirofumi Makino
    • 2
  • Seiichi Matsuo
    • 3
  • Tsuyoshi Watanabe
    • 4
  • Enyu Imai
    • 3
  • Kosaku Nitta
    • 5
  • Yasuo Ohashi
    • 6
  • Akira Hishida
    • 7
  • Chronic Kidney Disease Japan Cohort Study Group
  1. 1.Division of Nephrology, Department of MedicineShowa University School of MedicineTokyoJapan
  2. 2.Department of Medicine and Clinical ScienceOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
  3. 3.Department of NephrologyNagoya University Graduate School of MedicineNagoyaJapan
  4. 4.The Third Department of Internal MedicineFukushima Medical CollegeFukushimaJapan
  5. 5.Department of Medicine, Kidney CenterTokyo Women’s Medical UniversityTokyoJapan
  6. 6.Department of Biostatistics, School of Public HealthThe University of TokyoTokyoJapan
  7. 7.First Department of MedicineHamamatsu University School of MedicineShizuokaJapan

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