Treatment of Anemia among Women with Chronic Kidney Disease in United States Outpatient Settings

Aims: Women with chronic kidney disease (CKD) are often at risk for anemia. This study examined variations in anemia care and management among women with CKD in outpatient settings in the United States. Methods: The study utilized National Ambulatory Medical Care Survey (NAMCS) data from 1996 to 2003. Women aged 18 years or older with CKD were included based on ICD-9-CM codes for CKD, anemia, and reason for visit. Anemia-related medications were retrieved using NAMCS drug codes. Results: Approximately 58 million weighted outpatient visits for women with CKD were made. Nearly 14% of these visits were by Hispanic women and 50% visits were by patients aged 65 years or older. Nephrologists accounted for only 15% of CKD patient visits and 51% of these patients had anemia diagnosis. Additionally, 32% of patients were using 5 or more medications. Women with Medicare coverage were 2.6 times more likely (p < .05) to be diagnosed with anemia by a nephrologist and were 2.4 times more likely (p < .05) to receive a prescription to treat anemia than patients seen by non-nephrologists. Hispanic women were 56% less likely (p ≤ .05) to use 5 or more medications than non-Hispanic patients. CKD patients with anemia diagnosis were 50% less likely to receive 5 or more medications (p ≤ .05). Conclusion: This study found many risk factors associated with the diagnosis and treatment of anemia in women with CKD being treated in U.S. outpatient settings. Increased awareness of early treatments for anemia and assessments of patients receiving multiple medications is needed in women with CKD.