Impact of a Pharmacist-Implemented Anemia Management in Outpatients with End-Stage Renal Disease in Japan

Kimura, Takeshi; Arai, Masato; Masuda, Hiroya; Kawabata, Atsufumi

doi:10.1248/bpb.27.1831

Cited by 20 publications

(33 citation statements)

References 9 publications

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“…7,10,14 In the current study, differences in achieving hemoglobin targets did not reach statistical significance, but this lack of significance may be because the usual care group's achievement of hemoglobin targets was very high (96%) compared with other studies in which patients achieved their hemoglobin target only 17%-44% of the time. 6,10,14 Improvements in hemoglobin levels and ESA dose reductions in the current study may be attributed in part to better management of iron deficiency. A previous study found that a large number of patients with below-target hemoglobin levels …”

Section: ■■ Discussioncontrasting

confidence: 79%

“…10 Higher rates of iron monitoring and correction of laboratory-identified iron deficiencies in our study (75.0% vs. 46.0%) likely contributed not only to the high proportion of patients who achieved target hemoglobin but may have also contributed to the observed lower ESA doses in the clinical pharmacist-managed group.…”

Section: Impact Of a Clinical Pharmacy Anemia Management Service On Amentioning

confidence: 60%

“…[7][8][9][10] Nevertheless, previous studies found that a clinical pharmacist-managed anemia service improves adherence to monitoring guidelines 9 and produces superior or similar quality results to nonpharmacist management services using lower ESA doses. 7,10,14 In the current study, differences in achieving hemoglobin targets did not reach statistical significance, but this lack of significance may be because the usual care group's achievement of hemoglobin targets was very high (96%) compared with other studies in which patients achieved their hemoglobin target only 17%-44% of the time. 6,10,14 Improvements in hemoglobin levels and ESA dose reductions in the current study may be attributed in part to better management of iron deficiency.…”

Section: ■■ Discussionmentioning

confidence: 99%

“…4,5 The complexity of management, risks associated with inappropriate treatment, and high cost of ESA therapy make patients on these medications excellent candidates for pharmacist-based management. While anemia management services have demonstrated favorable impact on clinical and economic outcomes and patient satisfaction, [6][7][8][9][10][11] these have primarily used pre/post study designs, wherein the same patient population had its ESA therapy managed by a physician and then managed by a pharmacist and compared outcomes at different points in a patient's ESA therapy course. Unique to our study, both study groups were new starts on ESA therapy, and patients were managed via a centralized clinical pharmacy service using telephonic intervention.…”

Section: Patientsmentioning

confidence: 99%

See 3 more Smart Citations

Impact of a Clinical Pharmacy Anemia Management Service on Adherence to Monitoring Guidelines, Clinical Outcomes, and Medication Utilization

Debenito

Billups²,

Tran³

et al. 2014

JMCP

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Section: ■■ Discussioncontrasting

confidence: 79%

Section: Impact Of a Clinical Pharmacy Anemia Management Service On Amentioning

confidence: 60%

Section: ■■ Discussionmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

See 2 more Smart Citations

Impact of a Clinical Pharmacy Anemia Management Service on Adherence to Monitoring Guidelines, Clinical Outcomes, and Medication Utilization

Debenito

Billups²,

Tran³

et al. 2014

JMCP

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“…In addition, the majority of the studies were published in the United States. Interestingly, only one study [31] from Europe could be identified; three of the remaining four studies were from Asia [14,28,32], and one was from New Zealand [21]. However, we hypothesise that clinical pharmacists are widely engaged in the care of CKD and ESRD patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical pharmacy activities in chronic kidney disease and end-stage renal disease patients: a systematic literature review

Stemer

Lemmens‐Gruber

2011

BMC Nephrol

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BackgroundChronic kidney disease (CKD) and end-stage renal disease (ESRD) represent worldwide health problems with an epidemic extent. Therefore, attention must be given to the optimisation of patient care, as gaps in the care of CKD and ESRD patients are well documented. As part of a multidisciplinary patient care strategy, clinical pharmacy services have led to improvements in patient care. The purpose of this study was to summarise the available evidence regarding the role and impact of clinical pharmacy services for these patient populations.MethodsA literature search was conducted using the Medline, Embase and International Pharmaceutical Abstracts databases to identify relevant studies on the impact of clinical pharmacists on CKD and ESRD patients, regarding disease-oriented and patient-oriented outcomes, and clinical pharmacist interventions on drug-related problems.ResultsAmong a total of 21 studies, only four (19%) were controlled trials. The majority of studies were descriptive (67%) and before-after studies (14%). Interventions comprised general clinical pharmacy services with a focus on detecting, resolving and preventing drug-related problems, clinical pharmacy services with a focus on disease management, or clinical pharmacy services with a focus on patient education in order to increase medication knowledge. Anaemia was the most common comorbidity managed by clinical pharmacists, and their involvement led to significant improvement in investigated disease-oriented outcomes, for example, haemoglobin levels. Only four of the studies (including three controlled trials) presented data on patient-oriented outcomes, for example, quality of life and length of hospitalisation. Studies investigating the number and type of clinical pharmacist interventions and physician acceptance rates reported a mean acceptance rate of 79%. The most common reported drug-related problems were incorrect dosing, the need for additional pharmacotherapy, and medical record discrepancies.ConclusionsFew high-quality trials addressing the benefit and impact of clinical pharmacy services in CKD and ESRD patients have been published. However, all available studies reported some positive impact resulting from clinical pharmacist involvement, including various investigated outcome measures that could be improved. Additional randomised controlled trials investigating patient-oriented outcomes are needed to further determine the role of clinical pharmacists and the benefits of clinical pharmacy services to CKD and ESRD patients.

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A pharmacist‐managed dosing algorithm for darbepoetin alfa and iron sucrose in hemodialysis patients: A randomized, controlled trial

Oever

Heetman-Meijer

Birnie

et al. 2020

Pharmacology Res & Perspec

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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.

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Impact of a Pharmacist-Implemented Anemia Management in Outpatients with End-Stage Renal Disease in Japan

Cited by 20 publications

References 9 publications

Impact of a Clinical Pharmacy Anemia Management Service on Adherence to Monitoring Guidelines, Clinical Outcomes, and Medication Utilization

Impact of a Clinical Pharmacy Anemia Management Service on Adherence to Monitoring Guidelines, Clinical Outcomes, and Medication Utilization

Clinical pharmacy activities in chronic kidney disease and end-stage renal disease patients: a systematic literature review

A pharmacist‐managed dosing algorithm for darbepoetin alfa and iron sucrose in hemodialysis patients: A randomized, controlled trial

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