Evaluation of the management of anemia in hemodialysis patients in Lebanon

Abstract

Introduction: Chronic kidney disease (CKD) patients suffer anemia as one of the major complications. Optimal therapy involves the administration and response monitoring of erythropoiesis-stimulating agents and iron therapy.
Objectives: The purpose was to assess the adherence of anemia management in end-stage renal disease to Kidney Disease Outcomes Quality Initiative (KDOQI) recommendations. This study evaluated the impact of iron status on hemoglobin (Hb) levels, and its association with morbidity.
Patients and Methods: A prospective, multicenter, observational investigation was conducted at two hemodialysis (HD) centers over 6 months between 2013 and 2014. HD patients who aged more than 18 years without any history of active or chronic infection or cancer were enrolled. A total of 182 HD patients were included in the study.
Results: The included patients had a mean age of 57.28 years and mean Hb level of 10.29 ± 1.44 g/dL. A significant difference was noted between the prescribed and recommended doses of erythropoietin (EPO), along with that between prescribed and taken doses of EPO (P < 0.05). A significant difference was noted between the prescribed and taken iron doses (P < 0.05) in all months except December and April reflecting the association between the increase in Hb and adequate iron levels. Data on hospitalization was available for 78 individuals where Hb level was significantly lower in hospitalized versus non-hospitalized ones (9.92 versus 10.74 g/dL, P = 0.046).
Conclusion: Anemia management in HD patients depends on the adherence to the KDOQI recommendations for EPO dosing and iron status management. This sheds light on the need for the implementation of strict guidelines and clinical pharmacists’ involvement in HD units.

Keywords: Anemia management, Erythropoietin, Hemodialysis, Iron therapy, Morbidity