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

CKD Patients with Diabetes and Heart Disease Most Complex - Early Referral and Primary Care Education Needed -

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.

About ERA-EDTA

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.
www.nhsdirect.nhs.uk (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.