OBJECTIVES: Patients with anemia (hemoglobin: <13.0 g/dL [males]; <12.0 g/dL [females]) of non–dialysis-dependent chronic kidney disease (NDD-CKD) are at elevated risk of renal failure and cardiovascular (CV) disease, and are often untreated. We aimed to estimate the risk of CV/renal replacement (RR) events in at-risk patients with sub-optimally treated anemia of NDD-CKD from South Africa, Saudi Arabia, and the United Arab Emirates (UAE) using a quantitative model.

METHODS: CKD-specific risk equations were developed using individual data of stage 3–5 NDD-CKD patients with anemia recruited October 2002–December 2016 in the ongoing Salford Kidney Study using log-normal accelerated failure time models. Using these equations, our model projected the cumulative risks of RR (onset of dialysis/kidney transplant), CV (myocardial infarction [MI], unstable angina, coronary revascularization therapy, congestive cardiac failure, stroke, all-cause mortality [ACM]), and major adverse CV events (MACE; non-fatal MI/stroke/death due to CV event) over 1–15 years in at-risk population using country-specific population-level risk factors. Deterministic and probabilistic sensitivity analyses were performed to evaluate the model.

RESULTS: The base-case results estimated that a substantial number of patients with sub-optimally treated anemia of NDD-CKD would require RR within 15 years (South Africa [205,351]; Saudi Arabia [366,937]; UAE [109,880]). A notable number of patients are estimated to be at risk of CV and ACM (South Africa [193,745]; Saudi Arabia [260,166]; UAE [77,907]) and MACE (South Africa [34,904]; Saudi Arabia [44,853]; UAE [13,431]) events over the same timeframe.

CONCLUSIONS: The model projects a significant burden of illness associated with sub-optimally treated anemia of NDD-CKD in Saudi Arabia, South Africa, and the UAE over 15 years. However, these findings need to be validated with country-specific real-world data. These preliminary estimates may help physicians and policymakers to understand the magnitude of their at-risk population and the urgency of improving care for these patients.