Purpose Epoetin alpha is the standard of care for anemia treatment in stage 5 chronic kidney disease patients. A pharmacist-managed anemia program was developed to allow initiation and adjustment of epoetin and iron therapy. The goal of this study was to describe the pharmacist-managed anemia program in an outpatient hemodialysis clinic and evaluate the program by comparing the results to the US averages. Methods Dosing was completed by a clinical pharmacist using a psysician-approved protocol. Data were collected from May 2002 to June 2004. Results Two hundred seventy-eight patients and 1,379 patient monitoring-months were evaluated. The study population was 68.2% male, 86.3% African-American, and had an average age of 46 ± 13 years. The most common causes of renal disease were hypertension and diabetes mellitus. The average initial hemoglobin was 9.5 g/dL and was 11.8 gm/dL at 6 months. Iron parameters show an initial average ferritin of 280.9 ± 326.4 ng/mL with an iron saturation of 21 ± 7.9%. These parameters improved to a ferritin of 431 ± 232.1 ng/mL and iron saturation of 33 ± 8% at 6 months. Eighty percent of patients had a hemoglobin greater than 11 gm/dL compared to the US average of 75%. The average epoetin dose in this group was 121 units/kg/wk (9,300 units) compared to the US average of 229 units/kg/wk (16,000 units). The reduced epoetin doses used in this program resulted in an annual cost avoidance of $3,000 per patient. Conclusions Pharmacist management of anemia can provide cost-effective care in the chronic kidney disease population.

No abstract

On-call residents slept for a mean of six hours during overnight duty shifts, with half of the residents reporting sleep interruptions (a mean of 1.73 per shift). PVT results and KSS values indicated no overall decline in resident alertness during the study period.

No abstract