Document Detail

Prospective evaluation of an anemia treatment algorithm in hemodialysis patients.
MedLine Citation:
PMID:  9774126     Owner:  NLM     Status:  MEDLINE    
Current guidelines recommend maintaining the hematocrits of chronic hemodialysis patients in the low to mid-30s. Maintaining patients' hematocrits within a narrow range requires frequent monitoring of their hematocrits and iron studies and periodic adjustment of erythropoietin doses and administration of intravenous iron. We designed a simple anemia treatment algorithm to streamline the management of anemia in hemodialysis patients. The protocol required formal monthly decisions about the administration of intravenous iron or changes in erythropoietin dose. This algorithm was implemented by dialysis nurses and evaluated prospectively for 6 months in a single dialysis unit (30 patients). The proportion of patients whose hematocrits were within the desired target (31% to 35%) increased from 27% at baseline to 61% during months 4 through 6 of the algorithm. Conversely, the proportion of patients whose hematocrit values were below the target decreased from 46% at baseline to 18% during months 4 through 6 of the algorithm (P=0.004). The percentage of patients whose hematocrit values were above the target did not increase. The proportion of patients whose transferrin saturation was less than 18% decreased from 47% at baseline to 20% during months 4 through 6 of the algorithm (P=0.04). The weekly erythropoietin dose administered decreased from 11,200+/-1,400 units at baseline to 9,400+/-1,200 units in month 6 of the algorithm (P=0.06). We conclude that a simple anemia treatment algorithm implemented by dialysis nurses is feasible and efficacious and may increase the proportion of hemodialysis patients whose hematocrit values are within the target range, without increasing erythropoietin requirements.
P Patterson; M Allon
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  32     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  1998 Oct 
Date Detail:
Created Date:  1998-10-21     Completed Date:  1998-10-21     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  635-41     Citation Subset:  IM    
Nephrology Research and Training Center, University of Alabama at Birmingham, USA.
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MeSH Terms
Aged, 80 and over
Anemia, Iron-Deficiency / drug therapy*,  etiology
Erythropoietin / therapeutic use*
Middle Aged
Prospective Studies
Renal Dialysis / adverse effects*
Treatment Outcome
Reg. No./Substance:

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