Severe anemia is common and undertreated in adults with advanced kidney disease

Reviewed by Emily Henderson, B.Sc.Sep 28 2022

In an analysis of outpatient data from over 5 million adults, hemoglobin level was < 10 g/dl in over 20% with advanced kidney disease but less than 4% were treated with erythpoiesis-stimulating agents and iron testing was infrequent.

Anemia, a common complication of chronic kidney disease, is associated with adverse outcomes. Unfortunately, the use of erythropoiesis-stimulating agents (ESAs) to target a normal hemoglobin level has been associated with increased cardiovascular risk. This large study of over 5 million patients sought to describe the burden and risk factors associated with anemia by estimated glomerular filtration rate (eGFR) level.

In a study published in the American Journal of Kidney Diseases, researchers found that severe anemia was common and strongly associated with lower eGFR and multiple adverse outcomes. ESA use was rare. Although iron studies were checked infrequently, low iron test results were common in those tested. This highlights the need for increased testing of iron studies in patients with anemia, as iron supplementation is an effective and low-risk intervention.