Utilization patterns of erythropoiesis-stimulating agents for anemia in chronic kidney disease with diabetes

Abstract Background This study aimed to determine the prevalence of anemia in patients receiving diabetes care and to assess whether erythropoiesis-stimulating agents (ESAs) are appropriately utilized in clinical practice. Patient characteristics associated with non-use of ESAs were also investigated. This study analyzed 4,019 patients with diabetes mellitus, assessing anemia prevalence according to World Health Organization (WHO) criteria and the proportion of patients with hemoglobin levels (Hb) < 11 g/dL. Patients with anemia (Hb < 11 g/dL) were categorized as ESA users or non-users, and their clinical characteristics were compared. Results Based on the WHO classification, anemia prevalence tended to increase from chronic kidney disease (CKD) stage G3a in both sexes. Among patients with CKD-related anemia, ESA non-use was associated with female sex (odds ratio [OR] 0.196, 95% confidence interval [CI] 0.041–0.924), relatively preserved estimated globular filtration rate (OR 0.883, CI 0.833–0.935), and higher glycated albumin levels (OR 0.804, CI 0.687–0.940). Conclusions This study identified patient characteristics linked to ESA non-use in CKD-related anemia, suggesting possible clinical inertia in treatment decisions. These findings highlight gaps in anemia management among patients with diabetes, underscoring the need for more proactive therapeutic strategies.