title: Transfusion burden in non-dialysis chronic kidney disease patients with persistent anemia treated in routine clinical practice: a retrospective observational study.
abstract: BACKGROUND
  Transfusion patterns are not well characterized in non-dialysis (ND) chronic kidney disease (CKD) patients. This study describes the proportion of patients transfused, units of blood transfused and trigger-hemoglobin (Hb) levels for transfusions in severe anemic, ND-CKD patients in routine practice.
  
  
  METHODS
  A retrospective cohort study of electronic medical record data from the Henry Ford Health System identified 374 adult, ND-CKD patients with severe anemia (Hb < 10 g/dL and subsequent use of erythropoiesis-stimulating agents [ESA] therapy, blood transfusions, or a second Hb < 10 g/dL) between January 2004 and June 2008. Exclusions included those with prior diagnoses of cancer, renal or liver transplant, end-stage renal disease, acute bleeding, trauma, sickle cell disease, or aplastic anemia. A gap of ≥ 1 days between units of blood transfused was counted as a separate transfusion.
  
  
  RESULTS
  At least 1 transfusion (mean of 2 units; range, 1-4) was administered to 20% (75/374) of ND-CKD patients with mean (± SD) follow-up of 459 (± 427) days. The mean (± SD) Hb level closest and prior to a transfusion was 8.8 (± 1.5) g/dL. Patients who were hospitalized in the 6 months prior to their first anemia diagnosis were 6.3 times more likely to receive a blood transfusion than patients who were not hospitalized (p < 0.0001). Patients with peripheral vascular disease (PVD) were twice as likely to have a transfusion as patients without PVD (p = 0.04).
  
  
  CONCLUSIONS
  Transfusions were prevalent and the trigger hemoglobin concentration was approximately 9 g/dL among ND-CKD patients with anemia. To reduce the transfusion burden, clinicians should consider other anemia treatments including ESA therapy.
authors.affiliation: Strategic Healthcare Solutions, LLC, Monkton, MD 21111, USA. kathyfox@gforcecable.com
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Fox
authors.forename: Jerry
authors.initials: J
authors.lastname: Yee
authors.forename: Ze
authors.initials: Z
authors.lastname: Cong
authors.forename: John M
authors.initials: JM
authors.lastname: Brooks
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Petersen
authors.forename: Lois
authors.initials: L
authors.lastname: Lamerato
authors.forename: Shravanthi R
authors.initials: SR
authors.lastname: Gandra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D001803:Blood Transfusion / Q000191:economics; D017281:Cost of Illness; D057286:Electronic Health Records / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome