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The current analysis evaluated the impact of anemia on HRQoL and work productivity in patients with non-dialysis dependent and dialysis-dependent CKD using real-world data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were collected in France, Germany, Italy, Spain, the UK, the USA and China in 2012\u20132018 in the Adelphi Real World Disease Specific Programme\u2122 for CKD, a large, cross-sectional, survey of physicians and their patients. Patients completed three patient-reported outcomes (PRO) instruments: the EuroQol 5-Dimension 3-level (EQ-5D-3\u2009L), the Kidney Disease Quality of Life (KDQOL-36) instrument and the Work Productivity and Activity Impairment questionnaire. PROs were assessed by CKD stage and Hb levels, and regression analyses were performed with CKD stage and Hb level as independent variables and PROs as outcome variables, while adjusting for age, sex, CKD stage, comorbidities and cardiovascular risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, 5276 patients participated in the survey, including 28% stage 4 and 36% dialysis patients. Patients with lower Hb levels more often reported problems\/issues on all EQ-5D-3\u2009L domains (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u20090.0001). Regression analyses showed significant associations between lower Hb levels and the probability of low (&lt;\u20090.8) EQ-5D-3\u2009L utility scores (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u20090.0001) and low visual analog scale scores (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u20090.05), indicating poorer health status. Associations were seen even when adjusting for CKD stage and other potential confounding factors. Significant associations were observed between Hb level and the 12-Item Short-Form Health Survey (SF-12) Physical Component Summary, SF-12 Mental Component Summary and the three KDQOL-36 subscales (all\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u20090.0001), and were confirmed using linear regression analyses adjusting for CKD stage and other potential confounders. Numerically greater work productivity losses and greater activity impairment were observed with lower Hb levels.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Lower Hb levels worsen the impact of CKD on HRQoL, and are associated with lower work productivity in patients with CKD. Assessment and treatment of anemia should be recognized as a key component of integral CKD management throughout all stages of the disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12882-020-01746-4","type":"journal-article","created":{"date-parts":[[2020,3,6]],"date-time":"2020-03-06T19:04:18Z","timestamp":1583521458000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":105,"title":["Impact of chronic kidney disease and anemia on health-related quality of life and work productivity: analysis of multinational real-world data"],"prefix":"10.1186","volume":"21","author":[{"given":"Heleen","family":"van Haalen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Jackson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce","family":"Spinowitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Milligan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Moon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,3,7]]},"reference":[{"key":"1746_CR1","doi-asserted-by":"publisher","first-page":"e0158765","DOI":"10.1371\/journal.pone.0158765","volume":"11","author":"NR Hill","year":"2016","unstructured":"Hill NR, Fatoba ST, Oke JL, Hirst JA, et al. 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Therefore, ethics committee approval was not required. Prior to volunteering to complete a questionnaire, all patients were asked to provide written informed consent. The survey instructions describe the purpose of the survey, why the respondent had been selected and who might have access to the aggregated and anonymized dataset compiled.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"HvH is employed by AstraZeneca. JJ, RM and GM are employed by Adelphi Real World and declare no additional competing interests. BS reports research grants and\/ or consultation fees from AstraZeneca, Akebia, Bayer, GSK, and Reata.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"88"}}