Abstract: SA-PO234
Role of Nephrology Pharmacists in the Management of Anemia in Outpatient Dialysis Units: A Canadian Model
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
- El Nekidy, Wasim, Cleveland Clinic - Abu Dhabi, Windsor, Ontario, Canada
- Lee-St. John, Terrence J., Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Ghazi, Islam, Philadelphia College of Pharmacy/University of the Sciences, Wayne, Pennsylvania, United States
- Kadri, Albert, Windsor Regional Kidney Care Center, Windsor, Ontario, Canada
- Attallah, Nizar M., Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Soong, Derrick, Windsor Regional Hospital, Windsor, Ontario, Canada
Background
Hemodialysis patients frequently suffer from anemia. Proper utilization of therapies such as iron and erythropoiesis-stimulating agents (ESAs) are crucial to attain established hemoglobin targets. The purpose of this study was to evaluate the clinical and financial impact of nephrology trained pharmacists on anemia management in these patients
Methods
A retrospective study of patients who received hemodialysis between Jan 2010 and Dec 2011 in the outpatient hemodialysis units. In Dec 2010, pharmacists were tasked to manage anemia under medical directive. Primary endpoints were compared across years (2010 vs. 2011) using a mixed-effects model strategy An unstructured random effects correlation matrix was utilized to capture patient-level variation in 2010 and 2011 separately
Results
Of 202 patients, 163 contributed in both years, 57% were males, age 65.18± 16.3 years. Hemoglobin levels were 10.95±0.95 and 10.83±0.94 mg/dL in 2010 vs. 2011 respectively, p=0.158, while the transfusion rate was 1.3% and 1.8%, respectively, p=0.196. Ferritin levels 273.5±215 and 317.1±123, p=0.0019, iron saturation 0.30±0.11 and 0.30± 0.05, p=0.838, and Iron dose 215.4±100.2 and 317.1±123.7 mg, respectively, p= 0.996. Finally, the average weekly ESA use in 2010 was higher and trending up as compared to 2011 where it significantly trended down. Erythropoietin alfa dose 12315.6±7591 vs. 11364.1±5150, respectively, p=0.556 (figure1) with expenditure of 2.8 million CAD in 2010 vs. 2.3 million in 2011.
Conclusion
The participation of a nephrology trained pharmacist resulted in favourable outcomes in dose optimization (process), decreased expenditure (financial) and positive trends in therapeutic goal achievement coupled with reduced consumption (clinical)