ABSTRACT
An anemia management protocol ensures consistent treatment of anemia in end-stage renal disease (ESRD) patients by basing a treatment plan on the evaluation of hematocrit values and iron stores, the provision of safe and effective iron supplementation the systematic dosing of recombinant human erythropoietin (rHuEPO), and careful monitoring of patient' outcomes. The protocol must be designed specifically for the institution in which it will be implemented. This article outlines the steps an institution can take to develop and implement an anemia management protocol and includes a case study on how. The Centers for Dialysis Care in Cleveland. OH designed and implemented a protocol in their seven facilities.
Subject(s)
Algorithms , Anemia/therapy , Decision Trees , Drug Monitoring/methods , Erythropoietin/therapeutic use , Kidney Failure, Chronic/complications , Anemia/blood , Anemia/etiology , Clinical Protocols , Hematocrit , HumansABSTRACT
Iron deficiency is common in patients with end stage renal disease (ESRD) receiving recombinant human erythropoietin (rHuEPO). Consequently, such patients require routine iron monitoring by measurement of serum ferritin and transferrin saturation, with interpretation of these values in light of the response to rHuEPO. This article will review issues related to iron metabolism, the causes and diagnosis of absolute and functional iron deficiency, and treatment options for iron deficiency. In addition, the role of the nurse in iron management will be identified.
Subject(s)
Anemia, Iron-Deficiency/etiology , Anemia, Iron-Deficiency/therapy , Erythropoietin/therapeutic use , Ferrous Compounds/therapeutic use , Kidney Failure, Chronic/complications , Specialties, Nursing , Drug Monitoring , Humans , NephrologyABSTRACT
OBJECTIVE: To investigate the hematologic and economic advantages of using iron dextran as the sole supplemental agent to safely increase and maintain hematocrit levels and iron availability while optimizing erythropoietin dosing in patients on chronic hemodialysis. DESIGN: Iron dextran 100 mg (2 ml) was administered i.v. slow push, undiluted three times per week, sometime during the last 30 minutes of each hemodialysis treatment, until a total required ml (determined by using the package insert's formula) was attained. Maintenance doses of either 25 or 50 mg per week (dependent upon body weight) were administered ongoing to compensate for dialytic and gastrointestinal blood losses. The analysis duration was 12 months. SAMPLE/SETTING: A prospective analysis was performed on 13 clinically stable hemodialysis outpatients in a rural community hospital-based dialysis facility (mean age 56.4 years ranging from 24-76; sample included 9 males, 4 females). METHODS: The means and medians were calculated for each variable: hematocrit, ferritin, transferrin saturation, and erythropoietin dose. A one-tailed paired student t test was performed on doses of erythropoietin at -1 and 6 months, -1 and 9 months, and -1 and 12 months. Cost per patient of iron dextran loading dose and maintenance, as well as cost savings from actual erythropoietin dose reductions, were calculated at 3, 9, and 12 months. Cost savings reflected the cost of iron dextran. RESULTS: After 6 months on the protocol, erythropoietin doses decreased an average of 3100 units per patient with an 8% increase in hematocrit and 66% and 78% increase in transferrin saturation and ferritin, respectively. Based on averages in actual reduced erythropoietin dosing, a savings of +5,070 per patient per year was realized. CONCLUSIONS: This analysis found the use of iron dextran in the hemodialysis setting to be an effective and economic means to maintain hematocrit values and iron availability while optimizing erythropoietin dosing.
