Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
J Intern Med. 2023 Nov;294(5):628-639. doi: 10.1111/joim.13702. Epub 2023 Aug 4.
Anemia is a common complication of chronic kidney disease (CKD), but limited awareness and treatment options may hinder its management among CKD patients followed in primary care.
We evaluated adults with CKD stages 3-5 attending primary care in Stockholm, Sweden, 2012-2018. We assessed the incidence of anemia, clinical reactions, and association with subsequent major adverse cardiovascular events (MACE) and death.
We identified 45,637 patients with CKD stages 3-5 free from anemia (mean age 78 years; 64% females; 79% CKD stage 3b). During a median follow-up of 2.4 years, 26% of patients developed anemia, and 10.4% developed severe anemia (hemoglobin <10 g/dL). Within 6 months from the anemia event, iron tests were infrequent; ferritin and transferrin saturation were tested in 27% and 11% of anemia cases, respectively, and 49% and 24% of severe anemia cases. Few patients were recognized with a clinical diagnosis (15% of anemia cases; 68% of severe anemias). Only 19% of patients with anemia received treatment, primarily iron (10%) and blood transfusions (7%); erythropoietin-stimulating agent use was anecdotal (∼1%). Treatment rates for severe anemia were higher, but 43% of patients still failed to receive treatment. Developing anemia was associated with a higher risk of MACE and death.
Anemia was common and associated with adverse outcomes among patients with CKD stages 3-5 managed in primary care. Iron stores were infrequently tested, and a large proportion of patients with anemia remained untreated/under-recognized.
贫血是慢性肾脏病（CKD）的常见并发症，但由于对其认识有限且治疗选择有限，可能会阻碍初级保健中 CKD 患者对其的管理。
我们评估了 2012 年至 2018 年在瑞典斯德哥尔摩接受初级保健的 CKD 3-5 期的成年人。我们评估了贫血的发生率、临床反应以及与随后的主要不良心血管事件（MACE）和死亡的关系。
我们确定了 45637 名无贫血的 CKD 3-5 期患者（平均年龄 78 岁；64%为女性；79%为 CKD 3b 期）。在中位随访 2.4 年期间，26%的患者发生贫血，10.4%的患者发生严重贫血（血红蛋白<10g/dL）。在贫血事件发生后 6 个月内，铁检测不频繁；铁蛋白和转铁蛋白饱和度分别在 27%和 11%的贫血病例中进行了检测，在 49%和 24%的严重贫血病例中进行了检测。很少有患者被诊断出患有临床疾病（15%的贫血病例；68%的严重贫血病例）。只有 19%的贫血患者接受了治疗，主要是铁（10%）和输血（7%）；促红细胞生成素刺激剂的使用是偶然的（约 1%）。严重贫血的治疗率较高，但仍有 43%的患者未接受治疗。发生贫血与 MACE 和死亡风险增加相关。
在初级保健中管理的 CKD 3-5 期患者中，贫血很常见，并且与不良结局相关。铁储存很少被检测，很大一部分贫血患者未得到治疗/未被识别。
