Early Anemia Treatment Linked to Better Cardiovascular Outcomes in Nondialysis-Dependent CKD

A recent retrospective cohort study explored the impact of early versus delayed anemia treatment on renal and cardiovascular outcomes in patients with nondialysis-dependent (NDD) chronic kidney disease (CKD). 
 

Using data from two Japanese databases (Medical Data Vision Co. Ltd. and Real World Data Co. Ltd), the study analyzed patients who were initiated on long-acting erythropoiesis-stimulating agents (ESAs). 
 

Patients were classified into early (hemoglobin levels ≥9.0 g/dl) and delayed (<9.0 g/dl) treatment groups.
 

The primary outcome measured was a renal composite, including renal replacement therapy, significant reductions in estimated glomerular filtration rate (eGFR), and all-cause mortality, while secondary outcomes focused on cardiovascular events such as ischemic heart disease, stroke, heart failure, and cardiovascular death. 
 

After propensity score matching, 2,736 patients (1,472 from MDV and 1,264 from RWD) were included in the analysis.
 

The study found that delayed treatment was not associated with an increased risk of renal events. However, delayed treatment significantly increased the risk of cardiovascular outcomes, including heart failure and all-cause mortality. 
 

Specifically, delayed anemia treatment was linked to a higher risk of cardiovascular events (HR: 1.47, 95% CI: 1.16-1.84) and all-cause mortality (HR: 1.83, 95% CI: 1.32-2.54).
 

These findings highlight the importance of initiating anemia treatment early in NDD-CKD patients, before hemoglobin levels drop below 9.0 g/dl, to mitigate the risks of cardiovascular events and mortality.