Daniel Lorber

The prevalence of anemia in patients with chronic kidney disease

SUMMARY Objective: Anemia is a complication of chronic kidney disease and may contribute to adverse clinical outcomes. Early identification and treatment of anemia may improve cardiovascular morbidity and mortality. No large-scale population data are available specifically for patients with chronic kidney disease regarding prevalence of anemia, subpopulations at risk, and relationships between anemia and kidney function. This study was undertaken to address these questions in patients with chronic kidney disease, and investigate the relationship between anemia and glomerular filtration rate. Research design and methods: Large-scale, cross-sectional, US multicenter survey; 5222 patients (mean age, 68.2 years; 46.6% male); 237 physician practices. Eligible patients: ≥ 18 years of age; serum creatinine: 1.5 mg/dL–6.0 mg/dL (females), 2.0 mg/dL–6.0 mg/dL (males). Main outcome measures: Primary study end point: prevalence and severity of anemia (hemoglobin ≤ 12 g/dL). Data further stratified by hemoglobin (≤ 12 g/dL, ≤ 10 g/dL). Results: Primary etiologies of chronic kidney disease (5222 evaluable patients): diabetes (49.5%); hypertension (33.0%). Glomerular filtration rate: < 60 mL/min/1.73 m2 for 97.7% of evaluable patients. Mean ± SD serum creatinine level: 2.2 mg/dL ± 0.9 mg/dL; 2.5 mg/dL ± 1.0 mg/dL for males, 2.0 mg/dL ± 0.8 mg/dL for females. Mean ± SD hemoglobin: 12.2 g/dL ± 1.6 g/dL (47.7% had hemoglobin ≤ 12 g/dL; 8.9% had hemoglobin ≤ 10 g/dL). Prevalence of anemia was strongly associated with declining glomerular filtration rate. Percentage of patients with hemoglobin ≤ 12 g/dL increased from 26.7% to 75.5% when glomerular filtration rate decreased from ≥ 60 mL/min/1.73 m2 to < 15 mL/min/1.73 m2. Prevalence of hemoglobin ≤ 10 g/dL increased substantially from 5.2% to 27.2% when glomerular filtration rate diminished from ≥ 60 mL/min/1.73 m2 to < 15 mL/min/1.73 m2. After controlling for other patient characteristics associated with increased prevalence of anemia, the prevalence odds ratio for hemoglobin ≤ 10 g/dL was 0.54 (0.49–0.60) and for hemoglobin ≤ 12 g/dL was 0.68 (0.65–0.72), with each 10-mL/min/1.73 m2 increase in glomerular filtration rate. Predictors of anemia: diabetes, female sex, and race/ethnicity. Conclusions: Anemia was present in 47.7% of 5222 predialysis patients with chronic kidney disease. Prevalence of anemia increased as kidney function decreased. Certain subgroups are at increased risk for anemia.

GLP‐1 Receptor Agonists: Effects on Cardiovascular Risk Reduction

Comorbid obesity, dyslipidemia, and hypertension place patients with type 2 diabetes (T2DM) at greatly increased risk of cardiovascular (CV) disease-related morbidity and mortality. An urgent need exists for effective treatment for patients with T2DM that encompasses glycemic control, weight loss, and reduction in CV risk factors. The glucagon-like peptide-1 receptor agonists (GLP-1 RAs) liraglutide and exenatide are incretin-based antidiabetes agents. This review examines CV-associated effects of liraglutide and exenatide in animal models and clinical trials with patients with T2DM. Studies support the effectiveness of GLP-1 RAs in reducing hyperglycemia. Further, GLP-1 RAs represent a significant advance in T2DM treatment because they uniquely affect a broad array of CV risk factors through significant weight and systolic blood pressure reduction, improved lipid levels, and possibly, as shown in in vitro studies and animal models, through direct effects on cardiac myocytes and endothelium.

PREVALENCE AND TREATMENT OF ANEMIA WITH ONCE-WEEKLY EPOETIN ALFA IN PATIENTS WITH DIABETES AND CHRONIC KIDNEY DISEASE

OBJECTIVE To describe the characteristics and prevalence of anemia in patients with diabetes and chronic kidney disease (CKD) not receiving dialysis and to evaluate the efficacy and safety of once-weekly (QW) epoetin alfa for the treatment of anemia in these patients. METHODS Post hoc subset analyses were conducted for 2 studies: a prospective, multicenter survey evaluating the prevalence of anemia in patients with CKD (the Prevalence of Anemia in Early Renal Insufficiency [PAERI] study) and a prospective, multicenter, open-label trial evaluating the efficacy and safety of QW epoetin alfa for the treatment of anemia associated with CKD (the Clinical Evaluation of Procrit Dosed Once Weekly in Patients With Anemia Due to Early Renal Insufficiency [POWER] study). Patients in the POWER study received epoetin alfa, 10,000 U subcutaneously QW for up to 16 weeks. Each study subset consisted of patients with type 1 or type 2 diabetes. RESULTS More than 60% of patients in both studies had diabetes. In the PAERI study, 52.4% of the patients with diabetes (N = 3,361) had a hemoglobin (Hb) level < or = 12 g/dL, and 10.5% had Hb < or = 10 g/dL. Female sex, African American race, reduced kidney function, reduced transferrin saturation, and diabetes as the cause of CKD were strongly associated with anemia. In the POWER study, the mean Hb level in the patients with diabetes (N = 816) increased from 9.1 g/dL (baseline) to 11.6 g/dL (final); the mean increase in Hb from baseline was 2.4 g/dL (P<0.0001). Epoetin alfa therapy was associated with significant quality of life improvements and was well tolerated. CONCLUSION Diabetes is prevalent in patients with CKD not receiving dialysis, and anemia is prevalent among these patients. Epoetin alfa QW is safe and effective in treating anemia in these patients.