A predictive algorithm for the management of anaemia in haemodialysis patients based on ESA pharmacodynamics: better results for less work.
BACKGROUND
Many anaemia management algorithms recommend changes to erythropoiesis-stimulating agent (ESA) doses based on frequent measurement of haemoglobin levels in keeping with the ESA datasheets. We designed a predictive anaemia algorithm based on ESA pharmacodynamics, which we hoped would improve compliance with haemoglobin targets and reduce workload.


METHODS
A new algorithm was designed which predicted the 3-month steady-state haemoglobin concentration following a change in ESA dose and only recommended a change if it was outside the range 10.5-12.5 g/dL. Data were collected prospectively for 3 months prior and 15 months subsequent to implementing the algorithm.


RESULTS
A total of 214 prevalent dialysis patients were included in the audit. After 12 months, the haemoglobin concentration was 11.4 g/dL, near the midpoint of the target range, with a narrowing of the distribution (SD 1.46 to 1.25 g/dL, P < 0.0001). The proportion of patients with a haemoglobin level in the target range increased from 56% to 66% (P < 0.001) principally due to a reduction in the number of patients with high haemoglobin levels. There was no significant change in the ESA dose over the audit period. The number of prescription changes fell from 1/2.5 months to 1/6.1 months after 12 months (P < 0.001).


CONCLUSIONS
Switching prevalent haemodialysis patients to a predictive anaemia management algorithm improved compliance with haemoglobin targets, reduced the number of patients with high haemoglobin levels and reduced the number of ESA dose changes required.
Department of Renal Medicine, Lincoln Wing, St James’s University Hospital, Leeds, UK simonlines@doctors.net.uk
Simon W
SW
Lines
Elizabeth J
EJ
Lindley
James E
JE
Tattersall
Mark J
MJ
Wright
D000328:Adult; D000368:Aged; D000465:Algorithms; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D000068256:Darbepoetin alfa; D019468:Disease Management; D004921:Erythropoietin / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006397:Hematinics / Q000493:pharmacokinetics* / Q000627:therapeutic use; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D014018:Tissue Distribution
D006397:Hematinics; D006454:Hemoglobins; D004921:Erythropoietin; D000068256:Darbepoetin alfa