Retrospective Cohort Study using BC Renal Registered CKD and Dialysis Patients 2007- 2017 to describe hemoglobin distributions, anemia treatment patterns, and outcomes over time
In CKD and dialysis patients, we will be able to describe temporal changes in the proportion of patients with different levels of Hb, and treatments for those patients over a 10 year period, and describe rates of major adverse cardiovascular events (MACE) and all-cause mortality over the same time period. We hypothesize that there will be different proportions of patients with lower Hb receiving treatment with iron and ESA at different time points, and that the duration of untreated lower Hb values will be higher in more contemporary cohorts. We will explore the question as to whether there have been changes in MACE and all-cause mortality over time, in different groups of patients based on ESA use and Hb level.
3. Specific Research Objectives/Deliverables
1. We will describe the baseline characteristics of the CKD and dialysis populations in BC over the 10 year time course (2007- 2017) to demonstrate the similarity or differences in those characteristics over time.
a. Age, sex, ethnicity, aetiology of CKD
b. Comorbidities (as reliably available)
c. Other conditions
2. We will describe the proportion of patients within CKD stages, and on dialysis, with Hb values in various hemoglobin categories (130) using a point prevalent population in each calendar year.
a. Those receiving ESA and those not receiving ESA
b. Those receiving iron and those not receiving iron
c. Those receiving both / neither
3. We will explore if there are differences between those with similar Hb ranges and eGFR/ modality who are and are not receiving any ESA therapy, in each calendar year.
4. We will explore Hb levels at the time of ESA initiation, and ESA dose, in each calendar year, and the dose and Hb at 6 months in all those who initiated ESA within a calendar year.
5. We will explore the relationship of hemoglobin levels and time to outcomes including death, CV events and hospitalizations, as well as transfusions