Anaemia management and mortality risk in newly visiting patients with chronic kidney disease in Japan: The CKD-ROUTE study.
OBJECTIVE
To investigate the association between iron deficiency anaemia and mortality risk and assess the changes in anaemia and iron status after primary management by a nephrologist.


METHODS
In this prospective cohort study, we stratified 951 non-dialysis chronic kidney disease (CKD) G2-G5 patients newly visiting 16 nephrology centres into four groups according to the presence of anaemia with or without iron deficiency. All-cause mortality, cardiovascular (CV)-related mortality, and a change in anaemia and iron status after specialized primary care were the endpoints evaluated.


RESULTS
During a median follow-up time of 19 months, the number of all-cause deaths and CV-related deaths were 56 and 26, respectively. Compared with the control group, the groups with isolated anaemia and iron deficiency anaemia had significantly higher all-cause mortalities (isolated anaemia: hazard ratio (HR), 3.37; 95% confidence intervals (CI), 1.76-6.44; iron deficiency anaemia: HR, 3.11; 95% CI, 1.21-8.01) and CV-related mortalities (isolated anaemia: HR, 3.64; 95% CI, 1.36-9.73; iron deficiency anaemia: HR, 3.86; 95% CI, 1.11-13.41). In the isolated anaemia group, erythropoietin-stimulating agent (ESA) prescriptions significantly increased to approximately 70%. However, in patients with both anaemia and iron deficiency, iron prescriptions only increased to 48.1%.


CONCLUSIONS
Iron deficiency anaemia and isolated anaemia were associated with all-cause and CV-related mortality. The absence of relative increase in iron prescriptions suggests that iron deficiency should be accurately assessed and iron supplementation should be appropriately used to manage anaemia in non-dialysis patients with CKD.
Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
Soichiro
S
Iimori
Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
Shotaro
S
Naito
Department of Nephrology, Nakano General Hospital, Tokyo, Japan.
Yumi
Y
Noda
Department of Nephrology, Hiratsuka Kyosai Hospital, Kanagawa, Japan.
Hidenori
H
Nishida
Department of Nephrology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
Hiromi
H
Kihira
Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
Naofumi
N
Yui
Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
Tomokazu
T
Okado
Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
Sei
S
Sasaki
Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
Shinichi
S
Uchida
Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
Tatemitsu
T
Rai
D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D016009:Chi-Square Distribution; D019587:Dietary Supplements; D018450:Disease Progression; D005260:Female; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D007501:Iron / Q000097:blood / Q000627:therapeutic use*; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011320:Primary Health Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D006397:Hematinics; D007501:Iron
anaemia; cardiovascular disease; chronic kidney disease; iron deficiency; mortality