title: Impact of an anemia clinic on emergency room visits and hospitalizations in patients with anemia of CKD pre-dialysis.
abstract: OBJECTIVE
  There is limited data regarding the impact on hospital resource use of a dedicated, nurse-managed anemia clinic in patients with pre-end stage chronic kidney disease.
  
  
  METHODS
  A retrospective cohort study was conducted comparing patients with pre-end stage anemia of chronic kidney disease enrolled in an algorithmic anemia clinic (N = 27, treatment group) with un-enrolled patients with chronic kidney disease (N = 22, control group). The treatment group received algorithmic treatment with recombinant human erythropoietin and intravenous iron sucrose, while controls received usual care. The primary outcomes investigated were emergency room visits and hospitalizations during a 1-year period.
  
  
  RESULTS
  The two groups were similar at baseline. During the first year of clinic enrollment, the mean hemoglobin values improved in the treatment group from baseline and compared with controls (11.6 +/- 1.2 g/dl vs. 10.3 +/- 1.0 g/dl, p < 0.05). The relative risk of an emergency room visit (RR 0.18, 95% CI 0.05-0.67, p < 0.05) and hospitalization (RR 0.20, 95% CI 0.06-0.67, p < 0.05) were reduced in the treatment group versus the control group. The average length of hospital stay was also reduced (6.8 days vs. 9.5 days, p = 0.05).
  
  
  CONCLUSIONS
  Enrollment in a dedicated nurse-managed anemia clinic is significantly associated with reduced emergency room visits and hospitalizations in patients with pre-end stage CKD. These associative findings justify future prospective analyses to establish causality.
authors.affiliation: Department of Medicine/Nephrology Service, Walter Reed Army Medical Center, Washington, DC, USA. robert.perkins@na.amedd.army.mil
authors.forename: Robert
authors.initials: R
authors.lastname: Perkins
authors.forename: Stephen
authors.initials: S
authors.lastname: Olson
authors.forename: Janice
authors.initials: J
authors.lastname: Hansen
authors.forename: Joseph
authors.initials: J
authors.lastname: Lee
authors.forename: Kevin
authors.initials: K
authors.lastname: Stiles
authors.forename: Christopher
authors.initials: C
authors.lastname: Lebrun
mesh_terms: D000465:Algorithms; D000740:Anemia / Q000150:complications / Q000628:therapy*; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004921:Erythropoietin / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D011994:Recombinant Proteins; D006435:Renal Dialysis; D012189:Retrospective Studies
chemical_list: D011994:Recombinant Proteins; D004921:Erythropoietin