Red blood cell transfusion use in patients with chronic kidney disease

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2013-06, Vol.28 (6), p.1504-1515
• Main Authors: Gill, Karminder S, Muntner, Paul, Lafayette, Richard A, Petersen, Jeffrey, Fink, Jeffrey C, Gilbertson, David T, Bradbury, Brian D
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anemia - therapy; Erythrocyte Transfusion - utilization; Female; Follow-Up Studies; Glomerular Filtration Rate; Humans; Kidney Failure, Chronic - therapy; Male; Middle Aged; Prognosis; Renal Dialysis; Renal Insufficiency, Chronic - therapy; Survival Rate; Young Adult
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfs580

There is limited data available on the use of red blood cell (RBC) transfusions in younger chronic kidney disease patients not on dialysis (CKD-ND), for whom the consequences of developing antibodies to foreign antigens (allosensitization) may be particularly relevant. We used the Ingenix medical claims database, comprising data on ∼40 million commercially insured US individuals, to identify annual (2002-08) cohorts of patients 18-64 years of age with newly diagnosed CKD. We followed each cohort for 1 year to estimate RBC transfusion rates and used Cox proportional hazards regression to identify patient characteristics associated with time to first transfusion. We identified 120 790 newly diagnosed CKD patients for the years 2002-08; 54% were 50-64 years of age. Overall, the transfusion rate was 2.64/100 person-years (PYs) (95% CI: 2.52-2.77). Rates were higher among those with diagnosed anemia [9.80/100 PYs (95% CI: 9.31-10.3)] and among those who progressed to end-stage renal disease (ESRD) [28.0/100 PYs (95% CI: 23.7-33.0)]. For those progressing to ESRD, transfusion rates more than doubled between 2002 and 2008. Of the factors evaluated, transfusion history and the presence of heart failure and diabetes were most strongly associated with a receipt of a transfusion. RBC transfusions are relatively common and on the rise among younger CKD-ND patients who are anemic and progress to ESRD. Efforts to decrease the use of transfusions may be important for potential transplant candidates who progress to ESRD.