Blood transfusion use in non-dialysis-dependent chronic kidney disease patients aged 65 years and older.

BACKGROUND Erythropoiesis stimulating agents (ESA) have alleviated the need for blood transfusions in dialysis patients. Their impact on transfusion frequency in elderly chronic kidney disease (CKD) patients aged 65 years and older with non-dialysis-dependent CKD has not been studied. METHODS We conducted a retrospective cohort study of Medicare beneficiaries with CKD, point prevalent as of 1 January of each calendar year 1992-2004 (n = 301 000), and a concurrent group of beneficiaries without CKD (n = 15 772 039). During the entry year, we used administrative claim data to assemble a comorbidity profile for each participant. Transfusion event rates, ESA use and parenteral iron use were of primary interest. RESULTS CKD patients were at least four times more likely than non-CKD patients to receive transfusions. Transfusion rates adjusted for case mix fell from 194.2 transfusions per 1000 patient-years in 1992 to 112.2 in 2004. The decline in transfusions was highest for anaemic CKD patients receiving ESAs, which were given to 0.8% of CKD patients in 1992 and to 7.5% in 2004. CONCLUSIONS Transfusion use in non-dialysis-dependent CKD patients has decreased considerably but continues to be common. ESA use and possibly changed attitudes towards transfusion use explain most of the reduction noted.