Burden of illness associated with anaemia in chronic kidney disease in Japan: A literature review

Objectives: Identify the disease burden and treatment patterns associated with anaemia in Japanese patients with chronic kidney disease (CKD). Methods: According to PICO criteria, Medline®, Embase®, and Igaku Chuo Zasshi (ICHUSHI) databases were searched for observational studies, database analyses, and economic evaluations conducted in Japan, published from 2004 onward. Patient populations included Japanese CKD patients with anaemia, on or not on dialysis. Outcomes were epidemiological, economic, and humanistic burden, and treatment patterns. Results: Of 1030 references screened, 48 (Japanese, n= 27; English, n= 21) reported epidemiological (n= 23); economic (n= 36); and humanistic (n= 1) burden; or treatment patterns (n= 26). Anaemia prevalence, when defined as haemoglobin (HB) < 10 or < 11 g/dL, varied widely (13.8-95%; n= 5) among haemodialysis (HD) patients; four studies reported mortality rate (7.2-50%) in HD patients and two evaluated cardiovascular events. While 33 economic studies reported medication dosing, nine reported cost data; one reported a monthly cost of JPY 29,313-37,285 for anaemia management in peritoneal dialysis and HD patients, respectively, and none evaluated the direct impact of anaemia. One humanistic study reported quality of life using the Kidney Disease Quality of Life Instrument, and indicated that patients with Hb < 8 g/dL scored 1.6 points lower on the physical and mental component summaries than patients with Hb 11-12 g/dL. Fourteen of the 26 studies reporting treatment patterns included data on responsiveness to erythropoiesis stimulating agents (ESAs; darbepoetin alfa, epoetin alfa and beta, and epoetin beta pegol), ten reported dialysis duration, two reported time to dialysis initiation, four reported supplementary treatments, and one reported ferric citrate hydrate use. ConClusions: This literature review identified an abundance of data on medication dosing and treatment patterns, particularly regarding ESAs. However, the lack of humanistic and cost data reveals a need for further investigation of these outcomes among Japanese patients with anaemia and CKD.