Hemoglobin trajectory and a history of heart failure appear to guide treatment start. Anemia treatment is initiated in a limited number of NDD-CKD patients, even in those with guideline-based indications to treat. Discontinuation of anemia treatment was very common. Only 40% of patients with Hb < 10 g/dL received any anemia medication within a year. IV iron was prescribed to < 10% of patients with iron deficiency.

Heart failure was associated with earlier initiation of anemia medications. Patients with TSAT < 20% had a CIF of 26% and 6% for oral and IV iron, respectively. Even in patients with hemoglobin (Hb) < 10 g/dL, the CIF at 12 months for any anemia medication was 40%, and 28% for ESAs. We report the cumulative incidence function (CIF) of medication initiation stratified by baseline characteristics. We analyzed data from 2818 Stage 3-5 NDD-CKD patients from Brazil, Germany, and the US, naïve to anemia medications (oral iron, intravenous iron, or erythropoiesis stimulating agent ) at enrollment in the CKDopps. Previously lacking in the literature, we describe longitudinal patterns of anemia prescriptions for non-dialysis-dependent chronic kidney disease (NDD-CKD) patients under nephrologist care.

Hearts of iron 4 not responding