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Treatment for renal anemia and outcomes in non-dialysis patients with chronic kidney disease: the current status of regional medicine according to the Kyoto Fushimi Renal Anemia (KFRA) study

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Abstract

Background

The baseline data obtained in the CKD-JAC demonstrated that insufficient treatment was being provided for renal anemia by institutions specializing in renal disease. The objective of this study was to investigate the status of treatment for renal anemia, including renal/cardiovascular outcomes and mortality, at regional medical facilities since the development of long-acting erythropoiesis-stimulating agents (LA-ESA).

Methods

Non-dialysis outpatients with chronic kidney disease and renal anemia were eligible. Anemia was treated based on the clinical condition of each patient and targeted hemoglobin (Hb) levels.

Results

A total of 283 patients from 21 institutions were enrolled and followed up for a maximum of 3 years. A doubling of the serum creatinine level was observed in 89 patients, and renal replacement therapy was initiated in 57 patients. Multivariate Cox regression analysis revealed that a lower mean Hb level (mHb) and receiving fewer frequency of ESA during the follow-up period were independent determinants of the composite renal outcome and overall mortality. During the follow-up period, the percentages of patients with mHb of 10–10.9 g/dL and ≥ 11 g/dL were increased. Similar trends were seen regardless of whether the patients were treated by nephrologists or non-nephrologists. The frequency of ESA treatment was increased among the patients treated by non-nephrologists; however, it was much lower than nephrologists.

Conclusion

This study demonstrated that, in the era of LA-ESA treatment, higher Hb levels are associated with reduced composite renal outcomes at regional medical facilities. The importance of renal anemia management should be highlighted, even among non-nephrologists.

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Acknowledgements

The following is a list of the institutions that participated in this study: Department of Nephrology (Kensei Yahata, Koichi Seta, Yuko Kikuchi, Mitsuteru Koizumi, Maki Murata), Diabetes Center (Shigeo Kono, Reiko Nakagauchi, Junichiro Kishi, Yuri Kira), Department of Cardiology (Nobutoyo Masunaga, Mitsuru Ishii, Moritake Iguchi, Takashi Unoki, Kensuke Takabayashi, Yasuhiro Hamatani), Department of Endocrinology and Metabolism (Tetsuya Tagami, Mika Tuiki, Maiko Kakita), National Hospital Organization Kyoto Medical Center; Tsuji Clinic (Hikari Tsuji); Soseikai General Hospital (Shogo Murakami, Tomoko Tagawa); Ohishi Naika Clinic (Mariko Ohishi); Tojinkai Hospital (Tetsuya Hashimoto, Toru Takatani); Yoda Clinic (Junzo Yoda); Koide Clinic (Ayako Koide); Shishioka Clinic (Ichio Shishioka); Tsukuda Clinic (Nobuhiro Tsukuda); Haba Clinic (Tetsunori Haba); Kuroda Clinic (Osamu Kuroda); Matsumura Clinic (Satoshi Matsumura); Wada Naika Clinic (Shigeo Wada); Ito Clinic (Yoshiaki Ohmori); Kitani Clinic (Keiko Kitani); Kimura Clinic (Fumiaki Kimura); Sugano Clinic (Hiroko Tanaka); Taniguchi Clinic (Yoko Taniguchi); Tamagaki Naika Clinic (Toshiyuki Tamagaki); Furuke Clinic (Keizo Furuke); Matsushita Clinic (Norio Matsushita).

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Authors and Affiliations

  1. Department of Nephrology, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusa Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan

    Kensei Yahata, Koichi Seta, Yuko Kikuchi, Mitsuteru Koizumi & Maki Murata

  2. Division of Translational Research, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusa Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan

    Hiromichi Wada

  3. Department of Cardiovascular Medicine, Soseikai General Hospital, 101 Shimotoba Hiroosa-cho, Fushimi-ku, Kyoto, 612-8473, Japan

    Shogo Murakami

  4. Ohishi Naika Clinic, 38-1 Fukakusa Kareki-cho, Fushimi-ku, Kyoto, 612-0875, Japan

    Mariko Ohishi

  5. Tsuji Clinic, 5-8 Kogahonmachi, Fushimi-ku, Kyoto, 612-8492, Japan

    Hikari Tsuji

Authors
  1. Kensei Yahata
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  2. Koichi Seta
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  3. Yuko Kikuchi
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  4. Mitsuteru Koizumi
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  5. Maki Murata
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  6. Hiromichi Wada
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  7. Shogo Murakami
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  8. Mariko Ohishi
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  9. Hikari Tsuji
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Consortia

the Kyoto Fushimi Renal Anemia study investigators

  • Kensei Yahata
  • , Koichi Seta
  • , Yuko Kikuchi
  • , Mitsuteru Koizumi
  • , Maki Murata
  • , Shigeo Kono
  • , Reiko Nakagauchi
  • , Junichiro Kishi
  • , Yuri Kira
  • , Nobutoyo Masunaga
  • , Mitsuru Ishii
  • , Moritake Iguchi
  • , Takashi Unoki
  • , Kensuke Takabayashi
  • , Yasuhiro Hamatani
  • , Tetsuya Tagami
  • , Mika Tuiki
  • , Maiko Kakita
  • , Hikari Tsuji
  • , Shogo Murakami
  • , Tomoko Tagawa
  • , Mariko Ohishi
  • , Tetsuya Hashimoto
  • , Toru Takatani
  • , Junzo Yoda
  • , Ayako Koide
  • , Ichio Shishioka
  • , Nobuhiro Tsukuda
  • , Tetsunori Haba
  • , Osamu Kuroda
  • , Satoshi Matsumura
  • , Shigeo Wada
  • , Yoshiaki Ohmori
  • , Keiko Kitani
  • , Fumiaki Kimura
  • , Hiroko Tanaka
  • , Yoko Taniguchi
  • , Toshiyuki Tamagaki
  • , Keizo Furuke
  •  & Norio Matsushita

Corresponding author

Correspondence to Kensei Yahata.

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Conflict of interest

The authors have declared that no conflicts of interest exist.

Ethical approval

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number 12–43) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

The study participants treated at Kyoto Medical Center provided written informed consent, and those treated at other hospitals or clinics had the opportunity to refuse inclusion in this study by posting their details.

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The members of the Kyoto Fushimi Renal Anemia study investigators are listed in acknowledgements.

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Yahata, K., Seta, K., Kikuchi, Y. et al. Treatment for renal anemia and outcomes in non-dialysis patients with chronic kidney disease: the current status of regional medicine according to the Kyoto Fushimi Renal Anemia (KFRA) study. Clin Exp Nephrol 23, 1211–1220 (2019). https://doi.org/10.1007/s10157-019-01767-w

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  • DOI: https://doi.org/10.1007/s10157-019-01767-w

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