Haemoglobin (Hb) variation amongst people receiving haemodialysis is associated with higher mortality. The St. Vincent’s Health anaemia management model consists of initial dosing by nephrologists, monthly nurse practitioner (NP) adjustment using clinical practice guidelines, and 3 monthly nephrologist reviews. We examined the Hb range in our in-centre haemodialysis (ICHD) patients during 2007.
Patients treated with epoetin, on haemodialysis for > 6 months and under NP care were included (n=43). Hb was measured monthly and the annual range determined. A nurse-initiated iron protocol was used. Serum ferritin was monitored 1-2 monthly. Blood transfusion histories were analysed. The Renal Anaemia Management Database was used.
Three distinct groups were identified according to Hb ranges where variability was categorised as ‘Low’ (<20g/L,n=14), ‘Intermediate’ (20-30g/L,n=11) or ‘High’ (≥30g/L,n=18). The respective mean Hb for each group was 117, 112 and 111g/L (p=0.131) - all group averages within CARI recommendations. 56% of patients in the ‘high’ group had blood transfusions compared to one patient (7%, p=0.008) in the ‘low’ group and two patients (18%, p=0.04) in the ‘intermediate’ group. Ferritin targets were achieved in 96% of the ‘low’ & ‘intermediate’ groups and 72% in the ‘high’ group (p=0.05). There were no differences with regards to gender or ESA-type.
We conclude that NP care can achieve ‘low’ or ‘intermediate’ Hb variability in ICHD patients. A monthly CPG used for the haemodialysis population is very useful and may contribute to lower Hb variability. Furthermore, low variability is difficult to achieve if there are ongoing co-morbid conditions and hospital admissions.