title: Successful creation of an anemia management algorithm for hemodialysis patients.
abstract: BACKGROUND
  Several anemia guidelines for hemodialysis patients have recommended a target hemoglobin (Hb) range of 10-12 g/dL. However, maintaining Hb values continuously within a narrow target has been difficult, and there has been no generally accepted anemia management algorithm for hemodialysis patients.
  
  
  METHODS
  In our study, we created an anemia management algorithm that considers the length of erythrocyte lifetimes, focuses on the combination of erythropoiesis-stimulating agent management and iron administration, and prevents iron deficiency and overload. Our algorithm established a target Hb range of 10-12 g/dL.
  
  
  RESULTS
  We evaluated our algorithm in 49 patients for 6 months. The mean Hb values were approximately 11 g/dL during our study period. The percentage of patients in the target Hb range of 10-12 g/dL increased from 77.6% (38 of 49) at baseline to 85.7% (42 of 49) at 4-6 months. Throughout monthly regular blood tests during 1-6 months after we introduced our algorithm, Hb values remained within the target range in 55.1% (27 of 49) of patients. The standard deviation of Hb values significantly decreased at 5 and 6 months (P=0.013 and P=0.047, respectively; 1 g/dL at 0 month, 0.7 g/dL at 5 months, and 0.7 g/dL at 6 months). Our algorithm also succeeded in suppressing cumulative doses of iron (≤800 mg) and decreasing the ferritin values significantly (P=0.011). There were no significant differences in erythropoiesis-stimulating agent doses between 0 and 6 months (P=0.357).
  
  
  CONCLUSIONS
  Our anemia management algorithm successfully increased the number of patients in the target Hb range, significantly decreased the Hb standard deviation, suppressed cumulative doses of iron, and decreased ferritin values. These results suggest a better prognosis for hemodialysis patients. Further studies are required to evaluate our algorithm.
authors.affiliation: Department of Nephrology, Yokkaichi Social Insurance Hospital, Yokkaichi, Mie Prefecture, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hara
authors.affiliation: Department of Nephrology, Yokkaichi Social Insurance Hospital, Yokkaichi, Mie Prefecture, Japan.
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Mizutani
authors.affiliation: Department of Nephrology, Yokkaichi Social Insurance Hospital, Yokkaichi, Mie Prefecture, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kodera
authors.affiliation: Department of Nephrology, Yokkaichi Social Insurance Hospital, Yokkaichi, Mie Prefecture, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Miyake
authors.affiliation: Department of Nephrology, Yokkaichi Social Insurance Hospital, Yokkaichi, Mie Prefecture, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Yasuda
authors.affiliation: Department of Nephrology, Yokkaichi Social Insurance Hospital, Yokkaichi, Mie Prefecture, Japan.
authors.forename: Sanae
authors.initials: S
authors.lastname: Ohara
keywords: erythropoiesis-stimulating agent; ferritin; hemoglobin; hemoglobin standard deviation; iron; target hemoglobin range