Anemia Management in Non-Dialysis CKD Patients
- Anemia in CKD: Risk Factors, Practice Patterns, Therapies
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 200 Anemia and Iron Metabolism
- Bilal, Anum, Emory University, Atlanta, Georgia, United States
- Johnson, Yvette T., Emory University, Atlanta, Georgia, United States
- Oommen, Anju A., Emory University, Atlanta, Georgia, United States
Anemia is common in CKD and is closely associated with advanced stages of CKD. KDIGO recommends treating iron deficiency when TSAT is below 30% and administering ESA when Hb levels drop below 10 mg/dL. Current guidelines suggest maintaining Hb levels between 10-11.5 mg/dL. Despite this, anemia in CKD is often undertreated. This initiative aims to improve anemia management by addressing ESA hypo-responsiveness, administrative gaps, and missed treatments through quality improvements.
Our quality improvement project aimed to improve anemia management with two goals: 1) Increase Hb levels above 10 g/dL in at least 90% of patients on ESA for six months or more; 2) Decrease transfusion and hospitalization rates by 10%. To achieve these goals, we made minor changes in our clinic and utilized a new EMR system introduced in October 2022. The EMR system allowed for easy scheduling of follow-ups and labs, reducing administrative errors, and ensuring timely interventions. We upgraded the nursing ESA protocol by adding labs to screen for B12 and folate deficiencies. Nurses received re-education on ESA use and anemia management. Nurse Practitioner clinic was utilized to provide frequent follow-up for patients on home ESA, with a specific Retacrit protocol created for them. We maintained an "ESA panel" list to monitor and review patients on both home and in-clinic ESA for follow-up and outcomes.
The intervention phase started in February 2022, and we anticipate results in the coming months. Data extraction from the EMR system spanned its entire duration to measure changes over the last three quarters. Among the 4,000 clinic patients, 1,722 were diagnosed with anemia based on the ICD codes. Preliminary analysis shows a decrease in blood transfusions from 43 in the first quarter to 30 in the current quarter. Nephrology-ordered iron infusions decreased from 60 to 30, while the use of Retacrit increased from 8 to 17. These initial findings suggest the impact of our interventions on anemia management, but further analysis and evaluation are required to determine the full extent of improvements achieved.
Our study highlights the inadequate management of anemia in CKD patients, leading to avoidable healthcare utilization and compromising the chances of successful transplantation. Improved anemia management is urgently needed to address these concerns and optimize patient outcomes.