Anemia: An early complication of chronic renal insufficiency

The strong association between anemia and cardiovascular complications amon g patients with end-stage renal disease suggests that anemia during chronic renal insufficiency (CRI) may also have important consequences. We perform ed a retrospective cohort study to identify factors associated with severe anemia (hematocrit [Hct] < 30%) and examine anemia management practices in CRI. The CRI cohort was composed of 604 adult patients with elevated serum creatinine levels. There was a direct correlation between predicted glomeru lar filtration rate and Hct (r = 0.49) and an inverse correlation between s erum creatinine level and Hct (r = -0.37). Anemia was noted early in CRI; 4 5% of patients with serum creatinine levels of 2 mg/dL or less had an Hct l ess than 36%, and 8% had an Hct less than 30%. During the course of the stu dy, mean Hct decreased from 35.1% +/- 5.6% to 31.8% +/- 5.6%. Iron studies were obtained in only 19% of patients, and among these, the prevalence of i ron deficiency (transferrin saturation < 20%) was 54%. Only 30% and 26% of patients were administered recombinant human erythropoietin (rHuEPO) and ir on, respectively. Multivariate analyses showed that diabetes as the cause o f renal disease, greater serum creatinine level, and having a single nephro logy visit were associated with greater odds for the presence of anemia. A lower Hct and having a single nephrology visit were associated with greater odds for rHuEPO use. These results show that anemia begins early in the co urse of CRI, and management of anemia is suboptimal, even among patients un der the care of nephrologists. Educational programs to optimize anemia mana gement among patients with CRI are needed. <(c)> 2001 by the National Kidne y Foundation, Inc.