title: Effect of pharmacist management on serum hemoglobin levels with renal anemia in hemodialysis outpatients.
abstract: The initiation of a pharmacist-implemented management program to ensure appropriate use of erythropoietin-stimulating agents at Mizushima Kyodo Hospital is described. In the present study, we examined the influence of having pharmacists actively manage hemoglobin levels on therapeutic outcome in a retrospective study of 84 outpatients receiving hemodialysis. We compiled in-hospital guidelines for the use of erythropoietin and iron for outpatients with renal anemia. Pharmacists made recommendations, particularly about changes in the dose of erythropoietin and administration of iron preparations, to physicians. Clinical test results were monitored for 12 months (between November 2007 and October 2008) with and without the participation of pharmacists (continuous 6 months). The counseling by pharmacists significantly decreased hemoglobin levels in the high group (>12 g/dl) and significantly increased them in low group (<10 g/dl). Furthermore, it increased hemoglobin levels in the optimal group, suggesting the management of our hospital guidelines. On the other hand, low levels of hemoglobin indicated low levels of albumin. It is suggested that no improvement in hemoglobin levels may indicate low levels of albumin. These findings suggest that the active participation of pharmacists in the management of renal anemia in hemodialysis patients had a great therapeutic impact.
authors.affiliation: Department of Clinical Pharmaceutical Science, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Ohnishi
authors.forename: Akiyo
authors.initials: A
authors.lastname: Miyake
authors.forename: Keiko
authors.initials: K
authors.lastname: Kuwatsuka
authors.forename: Yuka
authors.initials: Y
authors.lastname: Onoue
authors.forename: Miyoshi
authors.initials: M
authors.lastname: Lee
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Koyama
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Sendo
authors.forename: Hiromu
authors.initials: H
authors.lastname: Kawasaki
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kitamura
mesh_terms: D000740:Anemia / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism*; D003157:Community Pharmacy Services; D054796:Drug Dosage Calculations; D016903:Drug Monitoring; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D017408:Guidelines as Topic; D006397:Hematinics / Q000627:therapeutic use; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007400:Interprofessional Relations; D007501:Iron / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000378:metabolism / Q000628:therapy*; D008297:Male; D010045:Outpatients; D010595:Pharmacists / Q000706:statistics & numerical data; D010820:Physicians; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D044967:Serum; D012709:Serum Albumin / Q000032:analysis / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D012709:Serum Albumin; D004921:Erythropoietin; D007501:Iron