Pharmacist-Managed Anemia Program in an Outpatient Hemodialysis Population

Abstract

Purpose Epoetin alpha is the standard of care for anemia treatment in stage 5 chronic kidney disease patients. A pharmacist-managed anemia program was developed to allow initiation and adjustment of epoetin and iron therapy. The goal of this study was to describe the pharmacist-managed anemia program in an outpatient hemodialysis clinic and evaluate the program by comparing the results to the US averages. Methods Dosing was completed by a clinical pharmacist using a psysician-approved protocol. Data were collected from May 2002 to June 2004. Results Two hundred seventy-eight patients and 1,379 patient monitoring-months were evaluated. The study population was 68.2% male, 86.3% African-American, and had an average age of 46 ± 13 years. The most common causes of renal disease were hypertension and diabetes mellitus. The average initial hemoglobin was 9.5 g/dL and was 11.8 gm/dL at 6 months. Iron parameters show an initial average ferritin of 280.9 ± 326.4 ng/mL with an iron saturation of 21 ± 7.9%. These parameters improved to a ferritin of 431 ± 232.1 ng/mL and iron saturation of 33 ± 8% at 6 months. Eighty percent of patients had a hemoglobin greater than 11 gm/dL compared to the US average of 75%. The average epoetin dose in this group was 121 units/kg/wk (9,300 units) compared to the US average of 229 units/kg/wk (16,000 units). The reduced epoetin doses used in this program resulted in an annual cost avoidance of $3,000 per patient. Conclusions Pharmacist management of anemia can provide cost-effective care in the chronic kidney disease population.