Abstract: SA-PO235
Anemia Nurse Manager in Peritoneal Dialysis: A Retrospective Study from Qatar
Session Information
- Anemia and Iron Metabolism: Clinical
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 202 Anemia and Iron Metabolism: Clinical
Authors
- Hamad, Abdullah Ibrahim, Hamad Medical Corporation, Doha, Qatar
- Ismail, Hany Ezzat, Hamad Medical Corporation, Doha, Qatar
- Futotana, Michelle cruz, Hamad Medical Corporation, Doha, Qatar
- Ibrahim, Rania Abdelaziz, Hamad Medical Corporation, Doha, Qatar
- Ramadan, Fatma Ahmed, Hamad Medical Corporation, Doha, Qatar
- Mohamed, Shehab, Hamad Medical Corporation, Doha, Qatar
- Lonappan, Vimala K., Hamad Medical Corporation, Doha, Qatar
- Ahmed, Hanaa, Hamad Medical Corporation, Doha, Qatar
- Al-Ali, Fadwa M., Hamad Medical Corporation, Doha, Qatar
Background
Anemia management is challenging in peritoneal dialysis (PD) patients (home-based with dependence on patients’ compliance). We implemented a special anemia nurse manager (ANM) model with nephrologist’s supervision in PD to achieve better hemoglobin (Hg) targets. We performed a retrospective study to evaluate outcomes and cost effectiveness of the new model.
Methods
Our PD ANM is a PD nurse who was trained for 4 months (8-12/2017) by a nephrologist. The program expanded gradually to include all PD patients by 1/2018. Our PDANM role includes lab review, medications adjustments, patients’ education and act as a focal point for anemia. We reviewed patients record for 1 year (1/2018-12/2018). We tracked laboratory values and medications. We performed root cause analysis (RCA) routinely to analyze and resolve challenges to achieve goals.
Results
PD census mean was 180 patients during study period (1/2018-12/2018). ANM model achieved a significant improvement in PD patients with Hg in target range (10-12g/dL) (54% in 1/2018 vs 75% in 12/2018 p=0.0004). Number of patients with extreme Hg (<9 g/dl or >13 g/dl) improved from 18% to 12% in the same period (p=0.03). Patients in ferritin target (200-800) improved (55% vs 69% p<0.005) without affecting iron saturation. Weekly Aranesp dose was reduced with the ANM model from 45mcg to 39mcg and monthly Mircera dose from 151mcg to 127mcg. Simple cost effectiveness analysis (saving in ESA consumption-nurse salary) showed estimated annual cost saving of 70000 dollars.Our RCA showed that the main cause of failure was compliance with visits and ESA shots. Based on our RCA we built a unique anemia management algorithm for PD (Figure 1).
Conclusion
Anemia management in PD was successfully shifted to our new ANM model. We were successful to achieve and maintain patients within anemia targets. The model was cost effective. We collaborated with a hematologist to address challenges. Similar models are applied throughout our dialysis service.