TY - JOUR
T1 - A pharmacist-managed dosing algorithm for darbepoetin alfa and iron sucrose in hemodialysis patients
T2 - A randomized, controlled trial
AU - van den Oever, Francisca Johanna
AU - Heetman-Meijer, Carolien F.M.
AU - Birnie, Erwin
AU - Vasbinder, Erwin C.
AU - Swart, Eleonora L.
AU - Schrama, Yvonne C.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - The attainment of target hemoglobin levels in hemodialysis patients is low. Several factors play a role, such as hyporesponsiveness to erythropoiesis-stimulating agents (ESA), but also suboptimal prescribing of ESA and iron. The goal of this study was to investigate if a pharmacist-managed dosing algorithm for darbepoetin alfa (DA) and iron sucrose improves the attainment of target hemoglobin levels. In this randomized controlled trial, 200 hemodialysis patients from a Dutch teaching hospital were included. In the intervention group (n = 100), a pharmacist monthly provided dose recommendations for DA and iron sucrose based on dosing algorithms. The control group (n = 100) received usual care. In the intervention group, the percentage per patient within the target range (PTR) for hemoglobin (target range 6.8-7.4 mmol/L) and iron status was higher than in the control group (for hemoglobin median 38.5% vs 23.1%, P =.001 and for iron status median 21.1% vs 8.3%, P =.003). The percentage of high hemoglobin levels (>8.1 mmol/L) was lower in the intervention group (median 0.0% vs 7.7%, P =.034). The weekly dose of DA was lower in the intervention group (median 34.0 vs 46.9 mcg, P =.020), whereas iron dose was higher (median 75 vs 0 mg). No difference was found for the percentage of hemoglobin levels below the target range. In conclusion, a pharmacist-managed dosing algorithm for DA and iron sucrose increased the attainment of target levels for hemoglobin and iron status, reduced the percentage of high hemoglobin levels, and was associated with a lower DA and a higher iron sucrose dose.
AB - The attainment of target hemoglobin levels in hemodialysis patients is low. Several factors play a role, such as hyporesponsiveness to erythropoiesis-stimulating agents (ESA), but also suboptimal prescribing of ESA and iron. The goal of this study was to investigate if a pharmacist-managed dosing algorithm for darbepoetin alfa (DA) and iron sucrose improves the attainment of target hemoglobin levels. In this randomized controlled trial, 200 hemodialysis patients from a Dutch teaching hospital were included. In the intervention group (n = 100), a pharmacist monthly provided dose recommendations for DA and iron sucrose based on dosing algorithms. The control group (n = 100) received usual care. In the intervention group, the percentage per patient within the target range (PTR) for hemoglobin (target range 6.8-7.4 mmol/L) and iron status was higher than in the control group (for hemoglobin median 38.5% vs 23.1%, P =.001 and for iron status median 21.1% vs 8.3%, P =.003). The percentage of high hemoglobin levels (>8.1 mmol/L) was lower in the intervention group (median 0.0% vs 7.7%, P =.034). The weekly dose of DA was lower in the intervention group (median 34.0 vs 46.9 mcg, P =.020), whereas iron dose was higher (median 75 vs 0 mg). No difference was found for the percentage of hemoglobin levels below the target range. In conclusion, a pharmacist-managed dosing algorithm for DA and iron sucrose increased the attainment of target levels for hemoglobin and iron status, reduced the percentage of high hemoglobin levels, and was associated with a lower DA and a higher iron sucrose dose.
KW - algorithm
KW - darbepoetin alfa
KW - hemodialysis
KW - iron sucrose
KW - pharmacist
UR - http://www.scopus.com/inward/record.url?scp=85088623148&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/prp2.628
DO - https://doi.org/10.1002/prp2.628
M3 - Article
C2 - 32715653
SN - 2052-1707
VL - 8
SP - e00628
JO - Pharmacology Research and Perspectives
JF - Pharmacology Research and Perspectives
IS - 4
M1 - e00628
ER -