title: Anaemia management in non-dialysis chronic kidney disease (CKD) patients: a multicentre prospective study in renal clinics.
abstract: BACKGROUND
  Knowledge on anaemia management in non-dialysis chronic kidney disease (ND-CKD) patients regularly followed in renal clinics is scarce although being essential to identifying areas of therapeutic improvement.
  
  
  METHODS
  We prospectively evaluated anaemia management in two visits, performed 6 months apart, in 755 prevalent ND-CKD stage 3b-5 patients followed in 19 nephrology clinics from ≥6 months. Anaemia was defined as severe (Hb <11 g/dL) or mild (Hb: 11-13.5 in males and 11-12 g/dL in females); iron deficiency (ID) was defined as transferrin saturation (TSAT) <20% and/or ferritin <100 ng/mL. Primary endpoint was the change of anaemia and ID prevalence between baseline and 6-month visit. Secondary endpoint was the prevalence of clinical inertia to either ESA or iron supplementation, that is, the lack of ESA or iron prescription despite Hb <11 g/dL or ID.
  
  
  RESULTS
  Age was 69 ± 13 years and GFR 27.5 ± 10.0 mL/min/1.73 m(2); male gender, diabetes and prior cardiovascular disease were 57.2, 30.1 and 30.1%, respectively. Prevalence of severe and mild anaemia was 18.0 and 44.0% at baseline and remained unchanged at Month 6 (19.3 and 43.2%). ID was prevalent at both visits (60.1 and 60.9%). Clinical inertia to ESA was similar at baseline and at Month 6 (39.6 and 34.2%, respectively, P = 0.487) and it was less frequent than clinical inertia to iron therapy (75.7 and 72.0%, respectively).
  
  
  CONCLUSIONS
  This study shows that anaemia prevalence is unexpectedly high in the setting of tertiary nephrology care. This was due to a persistent clinical inertia in the anaemia management, remarkable for iron supplementation and less critical, but still significant, for ESA treatment.
authors.affiliation: Dipartimento di Scienze Mediche, Chirurgiche, Neurologiche, Metaboliche e dell'Invecchiamento, Seconda Università di Napoli, Piazzale V. Tecchio 29, 80125 Napoli, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Minutolo
authors.forename: Francesco
authors.initials: F
authors.lastname: Locatelli
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gallieni
authors.forename: Renzo
authors.initials: R
authors.lastname: Bonofiglio
authors.forename: Giorgio
authors.initials: G
authors.lastname: Fuiano
authors.forename: Lamberto
authors.initials: L
authors.lastname: Oldrizzi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Conte
authors.forename: Luca
authors.initials: L
authors.lastname: De Nicola
authors.forename: Filippo
authors.initials: F
authors.lastname: Mangione
authors.forename: Pasquale
authors.initials: P
authors.lastname: Esposito
authors.forename: Antonio
authors.initials: A
authors.lastname: Dal Canton
mesh_terms: D000368:Aged; D000740:Anemia / Q000188:drug therapy* / Q000453:epidemiology; D019587:Dietary Supplements; D004921:Erythropoietin / Q000008:administration & dosage; D005260:Female; D005293:Ferritins / Q000008:administration & dosage; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000627:therapeutic use*; D007558:Italy / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications*
chemical_list: D006454:Hemoglobins; D004921:Erythropoietin; D005293:Ferritins; D007501:Iron
keywords: ESA; anaemia; chronic kidney disease; iron deficiency; iron therapy