Anemia prevalence and treatment patterns in chronic kidney disease: a nationwide observational study using a Japanese primary care database (2018-2023).

BACKGROUND

Anemia in chronic kidney disease (CKD) is associated with poor outcomes, including CKD progression, mortality, and cardiovascular events. Standard treatments include iron supplements and injectable erythropoiesis-stimulating agents (ESAs). Oral hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs) have recently emerged as a new treatment option, providing easier accessibility for general practitioners.

METHODS

This real-world descriptive study used the Japan Medical Data Survey database to analyze the prevalence of anemia, anemia treatment, and treatment type in non-dialysis patients with CKD and treated in primary care clinics. Data from 1 January 2018 to 31 December 2023 were assessed and analyzed by subgroups (year, CKD stage, patient age, treatment setting, sex, and region).

RESULTS

This study included 397,419 patients. Anemia treatment rates increased from 16.4% (2018) to 22.7% (2023), accompanied by an increased proportion of patients with hemoglobin levels ≥ 11 g/dL (78.8%-87.9%). From 2020, use of HIF-PHIs increased and use of ESAs decreased, with HIF-PHIs overtaking ESAs in 2022-2023. During 2022-2023 (N = 340,398), patients with more severe CKD stages had lower hemoglobin levels and an increased prevalence of anemia (11.6% [CKD G3a]-73.6% [CKD G5]). Older patients tended to have lower hemoglobin values, increased anemia prevalence, more severe CKD, and increased use of HIF-PHIs and ESAs.

CONCLUSION

Use of HIF-PHIs in primary care settings in Japan is increasing, resulting in changes to anemia treatment received by patients with CKD.