Successful creation of an anemia management algorithm for hemodialysis patients

Abstract

Introduction

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).

Conclusion

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.

Keywords:

• erythropoiesis-stimulating agent
• hemoglobin
• iron
• hemoglobin standard deviation
• target hemoglobin range
• ferritin

Acknowledgments

The authors sincerely appreciate the advice and comments from Daijo Inaguma.

Author contributions

All authors have contributed to the study. Kazuhiro Hara, Yasuhide Mizutani, Hitoshi Kodera, and Masato Miyake were the physicians in charge of patient care (including monitoring of Hb values), and they evaluated decisions made according to our anemia management algorithm. Yoshiki Yasuda and Sanae Ohara, clinical engineers, were in charge of supervising the implementation of our anemia management algorithm. Moreover, Yoshiki Yasuda and Sanae Ohara also contributed to the appropriate operation of the program that quickly made decisions based on our algorithm using Microsoft Office Excel^® 2007. All coauthors contributed equally to the critical revisions of this manuscript.

Disclosure

The authors report no conflicts of interest in this work.