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Incidence, Prevalence, and Treatment of Anemia of Non-dialysis-dependent Chronic Kidney Disease: a Retrospective Database Study in France

Karim Dardim, Jérôme Fernandes, Arnaud Panes, Julien Beisel, Aurélie Schmidt, Josephine Wolfram, Lora Todorova, Laurence Dubel, Thierry Lobbedez


Minimal data are available regarding the prevalence and incidence of anemia among patients with non-dialysis-dependent chronic kidney disease (NDD-CKD) in France. This was a retrospective non-interventional study of patients with a record of NDD-CKD in the Echantillon Généraliste des Bénéficiaires (EGB) database between January 01, 2012, and December 31, 2017. The primary objective was to estimate the annual incidence and prevalence of anemia of NDD-CKD. Secondary objectives included description of the demographics and clinical characteristics of patients with NDD-CKD-related anemia. An exploratory objective was to use machine learning to identify patients from the general population that might have NDD-CKD but without a recorded ICD-10 diagnosis of CKD.


Non-dialysis-dependent chronic kidney disease (NDD-CKD) is associated with a high burden of comorbidity, adverse clinical outcomes, and mortality [1–5]. A global meta-analysis of observational studies has estimated the global prevalence of NDD-CKD (stages 1–5) in the general adult population to be 13.4% (95% confidence interval [CI]: 11.7–15.1) [6].

Anemia is a common complication of CKD [7, 8] that develops in the early stages of the disease and increases with disease severity, affecting up to 90% of patients with stage 5 CKD [9, 10]. In a recent systematic literature review, anemia was consistently associated with greater mortality, hospitalizations, major adverse cardiovascular events (MACE), and CKD progression [9]. CKD patients with comorbid anemia and cardiovascular disease have been shown to have a significantly diminished quality of life [11].

Materials and method

EGB is a medico-administrative database of insured persons, and all patient-level data used for this retrospective analysis were collected as part of routine diagnosis and treatment. A unique anonymous identification number was associated to each insured person; as such, all data were fully anonymized prior to access and inclusion in this study. The Health Data Hub (a French public structure), and an independent scientific committee approved the access and use of the EGB to conduct this study on April 7, 2020 (dossier n°778539). Informed consent was not sought.


Among patients extracted from the EGB database, 9865 adults had confirmed NDD-CKD from 2012 to 2017. Approximately half (n = 4848, 49.1%) of these patients had anemia and one-third (n = 3855, 39.1%) had anemia plus records confirming their CKD stage (Figs 2A, 3).


This retrospective database study is the first to provide reliable estimates of incidence and prevalence of NDD-CKD and associated anemia in France. Nearly 10,000 adult patients with confirmed NDD-CKD were identified in the EGB database, around half of whom had evidence of anemia, as determined by codification of prescribed treatment for anemia or hospitalization with an anemia diagnosis, rather than a laboratory diagnosis. Despite differing definitions of anemia, this proportion of patients with anemia of CKD is consistent with published studies from other countries reporting anemia in approximately 40–60% of pre-dialysis CKD patients [10, 11, 27–30].


This retrospective analysis provides the first estimation based on patient-level data of the incidence and prevalence of NDD-CKD anemia in France, as well as an indication of the number of patients with potentially undiagnosed CKD. Initiatives to better identify and treat NDD-CKD anemia in the French population may improve outcomes, particularly for the two-thirds of patients with co-existing cardiovascular disease.


Data management and statistical analysis were provided by Gwendoline Poinsot of HEVA. Medical writing support was provided by Lisa O’Rourke, PhD, and Glen Dorrington, PhD, for Lumanity.

Citation: Dardim K, Fernandes J, Panes A, Beisel J, Schmidt A, Wolfram J, et al. (2023) Incidence, prevalence, and treatment of anemia of non-dialysis-dependent chronic kidney disease: A retrospective database study in France. PLoS ONE 18(7): e0287859.

Editor: Kathleen Bennett, Royal College of Surgeons in Ireland, IRELAND

Received: November 28, 2022; Accepted: June 14, 2023; Published: July 5, 2023

Copyright: © 2023 Dardim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Researchers may request access to anonymized participant-level data, trial-level data, and protocols from Astellas-sponsored clinical trials at For the Astellas criteria on data sharing, see: The authors did not have any special access privileges other authors would not have.

Funding: This study was financially supported by Astellas Pharma Inc. (, who also provided medical writing support. There are no grant or award numbers associated with this funding. This work was also supported by Astellas Pharma Inc. in the form of salary for LD and funding to Heva (, which paid salaries to AP, JB and AS who analyzed data from this study. The specific roles of these authors are articulated in the ‘author contributions’ section. The funders had no additional role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have read the journal’s policy and have the following competing interests: AP, JB and AS are paid employees of Heva ( LD is a paid employee of Astellas Pharma Inc. ( JW and LT are paid employees of Astellas Pharma Europe ( outside of the current study. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare.



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