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首页> 外文期刊>Nephrology. >Effects of proactive iron and erythropoiesis-stimulating agent protocol implementation on achieving clinical guideline targets for anaemia in a satellite haemodialysis patient cohort.
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Effects of proactive iron and erythropoiesis-stimulating agent protocol implementation on achieving clinical guideline targets for anaemia in a satellite haemodialysis patient cohort.

机译：积极的铁和促红细胞生成剂协议实施对在卫星血液透析患者队列中实现贫血临床指南目标的影响。

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AIM: Anaemia management with erythropoiesis-stimulating agents (ESA) and i.v. iron replacement in haemodialysis patients poses several clinical challenges, including maintaining stable haemoglobin (Hb) levels within target ranges while achieving lowest effective ESA dose. This manuscript describes the effect of implementing proactive protocol-driven adjustments for iron and ESA in maintenance haemodialysis patients. METHODS: This was a cohort study of 46 satellite haemodialysis patients examined from 2004 to 2006 with protocol implementation in 2005. Baseline haemoglobin, transferrin saturations (TSAT), ferritin values and ESA administration were obtained during 2004. Follow-up data was collected in 2006 and compared to baseline values in reference to specified targets in the 2004 Caring for Australasians with Renal Impairment (CARI) guidelines. RESULTS: Fifty-four percent of patients achieved haemoglobin targets during follow up versus 43% patients during baseline. Seventy-nine percent of patients achieved TSAT targets during follow up versus 67% patients during baseline. Ninety percent of patients achieved ferritin targets during follow up versus 75% patients during baseline. Odds ratios for values falling within target ranges during follow up compared to baseline were 1.63 (Hb: P = 0.037; 95% confidence interval (CI), 1.03-2.57), 1.90 (TSAT: P = 0.006; 95% CI, 1.20-3.01) and 3.72 (ferritin: P = 0.003; 95% CI, 1.57-8.83). There was a trend toward lower average ESA dose (P = 0.07). CONCLUSION: This study demonstrates the successful implementation and efficacy of a proactive protocol for iron and ESA treatment in haemodialysis patients. Benefits include increased concordance with historical guideline targets and decreased haemoglobin variability. Improved iron status and optimizing ESA response allows for lower ESA doses, limiting both potential side-effects of ESA (hypertension) and the burgeoning costs of anaemia management.
机译：目的：使用促红细胞生成剂（ESA）和静脉注射治疗贫血血液透析患者中​​的铁替代带来了几个临床挑战，包括在目标范围内保持稳定的血红蛋白（Hb）水平，同时获得最低的有效ESA剂量。该手稿描述了对维持性血液透析患者实施铁和ESA的前瞻性协议驱动的调整的效果。方法：这是一项队列研究，从2004年至2006年对46名卫星血液透析患者进行了检查，并于2005年实施了方案。2004年获得了基线血红蛋白，转铁蛋白饱和度（TSAT），铁蛋白值和ESA的使用。2006年收集了随访数据。并与参考2004年护理患有澳大利亚肾病（CARI）指南的特定目标的基线值进行比较。结果：有54％的患者在随访期间达到了血红蛋白目标，而基线时为43％。在随访期间，有79％的患者达到了TSAT目标，而在基线期间则为67％。随访期间有90％的患者达到了铁蛋白目标，而基线期间有75％的患者达到了铁蛋白目标。与基线相比，随访期间处于目标范围内的值的赔率为1.63（Hb：P = 0.037; 95％置信区间（CI），1.03-2.57），1.90（TSAT：P = 0.006; 95％CI，1.20- 3.01）和3.72（铁蛋白：P = 0.003; 95％CI，1.57-8.83）。平均ESA剂量有降低的趋势（P = 0.07）。结论：这项研究证明了在血液透析患者中​​积极实施铁和ESA治疗方案的成功实施和疗效。好处包括增加与历史指南目标的一致性以及减少血红蛋白变异性。改善铁质状况和优化ESA反应可降低ESA剂量，从而限制ESA的潜在副作用（高血压）和贫血管理的新兴成本。

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