First ERA-EDTA 'CKD Anaemia Physician Behaviours Survey' Reveals Complexities of CKD Anaemia Management


The European Renal Association-European Dialysis Transplant Association (ERA-EDTA) today announced results from the first ever Chronic Kidney Disease (CKD) Anaemia Physician Behaviours Survey, commissioned by ERA-EDTA and sponsored by an educational grant from Amgen. Nephrologists surveyed say that the majority of CKD anaemia patients (59.5 percent) also suffer from diabetes and heart disease. Three quarters of nephrologists (74 percent) describe these patients as complex to manage(1), suggesting a critical need for more proactive intervention.

The survey, conducted by independent research agency Harris Interactive, polled 369 nephrologists across five European countries (Germany, France, Italy, United Kingdom and Spain) in May and June 2007 to investigate unmet needs and real world challenges faced by physicians in managing CKD anaemia patients.

Alarming results show that nearly half of patients are referred to nephrologists at an advanced stage of the disease – CKD stage four or above. When questioned on how to optimise CKD anaemia management, three quarters (75 percent) of physicians called for increased understanding of CKD in primary care, and 82 percent called for routine eGFR (estimated glomerular filtration rate) testing in the primary care setting in order to improve diagnosis and referrals.

“Patients in advanced stages of CKD have more related conditions such as diabetes and heart disease, significantly adding to the complexity of CKD anaemia management,” explains ERA-EDTA President, Professor Jorge B. Cannata-Andia. “Because these comorbidities reduce patients’ quality of life and overall life expectancy, there is real need to diagnose and refer patients at a much earlier stage to reduce the high burden of morbidity and mortality associated with CKD.”

CKD anaemia patients, particularly those with diabetes and heart disease, often suffer from fluctuations in their haemoglobin (Hb) levels. Maintaining stable Hb levels is a key element of effective CKD anaemia management.(2) Nearly half (47 percent) of physicians surveyed stated that stabilising Hb levels within target range is achieved through the management of a combination of factors such as intercurrent events (kidney inflammation, bleeding, hospitalisations and infections), clinical practice patterns and use of management tools. Only 5 percent believe that the choice of erythropoietin stimulating agent (ESA) treatment alone is an important factor in maintaining Hb stability. Furthermore, results show that physicians stay well within the European Best Practice Guidelines for the Management of Anaemia (greater than or equal to 11g/dl, not to exceed 14g/dl).(1,3)

“It is vital that patients’ Hb levels are controlled within the target range in order to limit adverse effects,” commented Professor Francesco Locatelli, Head of Nephrology at A. Manzoni Hospital, Lecco, Italy, past President of ERA-EDTA and Chairman of the European Best Practice Guidelines. “These results support the need for flexible management, improved primary care education and CKD awareness programmes to improve diagnosis, achieve Hb stability, keep patients within the recommended range and help diminish the complexity of CKD.”

To address the growing complexity of anaemia management, the majority of physicians surveyed listed ‘flexibility of dosing frequency, such as weekly to monthly’ (64 percent) and ‘proven safety profile in clinical practice’ (62 percent) as the top two most important factors of an ESA in effective management of CKD anaemia for physicians and their patients.

About CKD Anaemia

Anaemia is one of the most common symptoms of CKD.(4) It occurs when failing kidneys no longer produce sufficient erythropoietin, a hormone that stimulates the production of oxygen-carrying red blood cells (RBCs) that contain haemoglobin, a red, iron-rich protein that carries oxygen from the lungs to the body’s tissues. Anaemia occurs when the number of RBCs (or the Hb in them) falls below normal levels (normal Hb levels are between 13.5 to 18g/dl for men and 11.5 to 16g/dl for women).(5)

Anaemia can be a serious disease that is often under-diagnosed and under-treated.(6) When anaemia occurs, the body gets less oxygen and therefore has less energy than it needs to function properly. The major symptoms of anaemia include fatigue, weakness, shortness of breath, difficulty concentrating or confusion, dizziness or fainting, pale skin, rapid heartbeat and feeling unusually cold.

Anaemia often develops early in CKD(7) and some studies suggest that the majority of patients are anaemic the first time they see a nephrologist.(6) Studies also suggest that 20-40 percent of patients in Europe are not achieving target Hb levels.(8)

About the ERA-EDTA CKD Anaemia Physician Behaviours Survey

The CKD Anaemia Physician Behaviours Survey is the first major study of its kind to ask nephrologists questions to gather “real world answers” on current trends, behaviours and future research needs in CKD anaemia. It is a pan-European survey of 369 nephrologists across Germany, France, Spain, Italy and the UK. Participating nephrologists have been in practice at least two years and treat at least 15 patients per month. Interviews took place in May and June 2007.

The survey was commissioned by the ERA-EDTA, conducted by independent market research agency, Harris Interactive and sponsored by an educational grant from Amgen.


The European Renal Association-European Dialysis and Transplant Association, founded in 1964, accounts for more than 5,000 active members. Its purpose is to encourage and to report advances in the field of clinical nephrology, dialysis, renal transplantation and related subjects.

(1) References: CKD Anaemia Physician Behaviours Survey. Harris Interactive. June 2007.

(2) Carrera F. Tailored anaemia management in patients with chronic kidney disease. Eur Renal and Gen-Uri Dis.2006: 31-34.

(3) Locatelli F, Aljama P, Barany P et al. Revised European best practice guidelines for the management of anaemia in patients with chronic renal failure. Nephrol Dial Transplant. 2004 May; 19 Suppl 2: ii1-47

(4) Shibagaki Y, Shetty A. Anaemia is common after kidney transplantation, especially among African Americans. Nephrol Dial Transplant 2004; 19: 2368-2373

(5) NHS Direct UK. Health Encyclopaedia: Anaemia. (Accessed June 2007).

(6) Valderrabano F. Anaemia management in chronic kidney disease patients: an overview of current clinical practice. Nephrol Dial Transplant 2002; 17 (Suppl 1): 13-18.

(7) Obrador GT, Pereira BJG. Anaemia of chronic kidney disease: an underecognised and under-treated problem. Nephrol Dial Transplant 2002; 17 (Suppl 11): 44-46

(8) Locatelli F et al. Anemia management for hemodialysis patients: kidney disease outcomes quality initiative (K/DOQI) guidelines and dialysis outcomes and practice patterns study (DOPPS) findings. American Journal of Kidney Diseases 2004; 44(5) (Suppl 2): S27-S33.
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