Zaoui Philippe, Courivaud Cecile, Rostoker Guy, Choukroun Gabriel, Dubel Laurence, Lorenzo Maria, Harmand Sarah, Menoyo Calonge Victorio
CHU Grenoble-Alpes & AGDUC, Grenoble, Isère, France.
CHU Besançon, Besançon, Doubs, France.
Clin Kidney J. 2022 Nov 2;16(3):501-511. doi: 10.1093/ckj/sfac245. eCollection 2023 Mar.
Limited real-world data are available in Europe, especially France, regarding the therapeutic management of anaemia in patients with dialysis-dependent chronic kidney disease (DD CKD).
This retrospective, longitudinal, observational study was based on medical records from the MEDIAL database of not-for-profit dialysis units in France. From January to December 2016, we included eligible patients (≥18 years), with a diagnosis of CKD and receiving maintenance dialysis. Patients with anaemia were followed up for 2 years after inclusion. Patient demographic data, anaemia status, CKD-related anaemia treatments, and treatment outcomes including laboratory test results were evaluated.
Of 1632 DD CKD patients identified from the MEDIAL database, 1286 had anaemia; 98.2% of patients with anaemia were receiving haemodialysis at index date (ID). Of patients with anaemia, 29.9% had haemoglobin (Hb) levels of 10-11 g/dL and 36.2% had levels of 11-12 g/dL at ID. Furthermore, 21.3% had functional iron deficiency and 11.7% had absolute iron deficiency. The most commonly prescribed treatments at ID for patients with DD CKD-related anaemia were intravenous (IV) iron with erythropoietin-stimulating agents (ESAs) (65.1%). Among patients initiating ESA treatment at ID or during follow-up, 347 (95.3%) reached the Hb target of 10-13 g/dL and maintained response within the target Hb range for a median duration of 113 days.
Despite combined use of ESAs and IV iron, duration within the Hb target range was short, suggesting that anaemia management can be further improved.
在欧洲，尤其是法国，关于依赖透析的慢性肾脏病（DD CKD）患者贫血治疗管理的真实世界数据有限。
这项回顾性、纵向观察性研究基于法国非营利性透析单位MEDIAL数据库中的医疗记录。2016年1月至12月，我们纳入了符合条件的患者（≥18岁），这些患者被诊断为CKD并接受维持性透析。贫血患者在纳入后随访2年。评估患者的人口统计学数据、贫血状态、CKD相关贫血治疗以及包括实验室检查结果在内的治疗结局。
从MEDIAL数据库中识别出的1632例DD CKD患者中，1286例患有贫血；98.2%的贫血患者在索引日期（ID）接受血液透析。在贫血患者中，29.9%的患者在ID时血红蛋白（Hb）水平为10 - 11 g/dL，36.2%的患者水平为11 - 12 g/dL。此外，21.3%的患者存在功能性缺铁，11.7%的患者存在绝对性缺铁。ID时DD CKD相关贫血患者最常用的治疗方法是静脉注射（IV）铁剂联合促红细胞生成素（ESA）（65.1%）。在ID或随访期间开始接受ESA治疗的患者中，347例（95.3%）达到了10 - 13 g/dL的Hb目标，并在目标Hb范围内维持反应的中位持续时间为113天。
尽管联合使用了ESA和IV铁剂，但在Hb目标范围内的持续时间较短，这表明贫血管理仍可进一步改善。
