ABSTRACT
Anemia associated with end stage renal disease can diminish quality of life substantially. Maintaining a stable hematocrit and stable hemoglobin levels affords many advantages. Improvement of anemia management is possible with the implementation of continuous quality improvement (CQI). Our review of the literature motivated us to switch from iron dextran injection, which can induce anaphylactic reactions and has other associated problems, to sodium ferric gluconate complex injection. This enables us to safely provide iron supplementation without the precautions that were in place for iron dextran. Our methods for creating and implementing CQI in the dialysis program at our university hospital are described.
Subject(s)
Anemia, Iron-Deficiency/drug therapy , Anemia, Iron-Deficiency/etiology , Ferric Compounds/therapeutic use , Kidney Failure, Chronic/complications , Renal Dialysis/adverse effects , Total Quality Management/organization & administration , Algorithms , Anaphylaxis/chemically induced , Anemia, Iron-Deficiency/blood , Anemia, Iron-Deficiency/diagnosis , Decision Trees , Erythropoietin/therapeutic use , Ferritins/blood , Hemoglobins/analysis , Humans , Iron-Dextran Complex/adverse effects , Kidney Failure, Chronic/therapy , Outcome and Process Assessment, Health Care/organization & administration , Practice Guidelines as Topic , Renal Dialysis/methods , Transferrin/metabolismABSTRACT
An inadequate response to recombinant human erythropoietin (rHuEPO) therapy may be attributable to many underlying causes, with the major cause being iron deficiency. Since improved rHuEPO response can improve quality of life in end-stage renal disease (ESRD) patients, rHuEPO resistance should be investigated and corrected whenever possible. This article will discuss the Winthrop-University Hospital's continuous quality improvement (CQI) initiative that was developed to improve recognition and treatment of rHuEPO resistance.
Subject(s)
Anemia/etiology , Anemia/therapy , Erythropoietin/therapeutic use , Kidney Failure, Chronic/complications , Algorithms , Case Management , Clinical Protocols , Drug Resistance , Humans , Patient Education as Topic , Risk Factors , Total Quality Management/organization & administrationABSTRACT
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.
