Credit: Original article published here.
According to Jake Hunnicutt, PhD, and colleagues, there are few data on the use of red blood cell transfusion among patients with anemia and nondialysis dependent chronic kidney disease (CKD) in the United States. Data on how the rates of red blood cell transfusion vary by hemoglobin level are also limited.
During a poster session at the National Kidney Foundation Spring Clinical Meetings 2023, the researchers presented data on the rate of red blood cell transfusions and associated complications from 2017 to 2019. The poster was titled Red Blood Cell (RBC) Transfusion Use Varies by Baseline Hemoglobin (Hb) and Is Associated With Posttransfusion Hyperkalemia and Hospitalization Within 30 Days in US Patients With Stage 3-5 CKD and Anemia.
The retrospective cohort study utilized Optum’s deidentified Integrated Claims-Clinical dataset. Inclusion criteria were hemoglobin measure (index date), prior evidence of stage 3-5 CKD, and anemia (defined as treatment for anemia or baseline hemoglobin <12 g/dL for women or <13 g/dL for men). Analyses were stratified by insurance type (commercial or Medicare Advantage [MA]).
Associations between baseline hemoglobin and red blood cell transfusion events within 6 months were quantified using estimated adjusted rate ratios (aRR) and 95% CIs. Claims data were used to identify episodes of hyperkalemia and all-cause hospitalization with 30 days of initial red blood cell transfusion.
The study cohort included 10,712 patients with commercial insurance (54% female, mean age 58.8 years) and 64,554 patients with MA (59% female, mean age 77.8 years). During the 1-year baseline period, only 2.8% of commercially insured patients and 2.1% of the MA-insured patients received intravenous iron. During that period, only 1.2% of the commercial insurance group and 1.2% of the MA group were treated with erythropoiesis-stimulating agents (ESAs).
During follow-up, there was an association between lower baseline hemoglobin and an increased rate of red blood cell transfusion events. Within 30 days of the initial red blood cell transfusion, hyperkalemia was observed in 12.7% of patients in the commercial insurance group and in 12.1% of those in the MA insurance group. During that same period, 35.8% of those in the commercial insurance group and 46.1% of those in the MA group had one or more hospitalizations.
In summary, the researchers said, “Red blood cell transfusion was more common in patients with nondialysis-dependent stage 3-5 CKD and anemia between 2017 and 2019, and more frequent in patients with low baseline hemoglobin. Baseline use of iron and ESAs was low. Hyperkalemia and hospitalizations were common following a transfusion.”
Source: Red blood cell (RBC) transfusion use varies by baseline hemoglobin (Hb) and is associated with posttransfusion hyperkalemia and hospitalization within 30 days in US patients with stage 3-5 CKD and anemia. Poster #182. Abstract of a poster presented at the National Kidney Foundation Spring Clinical Meetings 2023; April 11-15, 2023; Austin, Texas. Funding for the study was provided by GSK plc (Study 218794).
