Impact of a pharmacist-implemented anemia management in outpatients with end-stage renal disease in Japan.

Given the absence of standard guidelines for use of recombinant human erythropoietin in patients with end-stage renal disease in Japan, in the present study, pharmacists actively managed the erythropoietin therapy, and the therapeutic and pharmacoeconomic outcome was evaluated. We compiled in-hospital guidelines for proper use of erythropoietin for outpatients with renal anemia under hemodialysis, and made recommendations, particularly about changes in the doses of erythropoietin and administration of iron preparations, to physicians. The clinical test values and the dosages of erythropoietin were monitored for 9 months and analyzed. As results of our participation, the number of renal anemia patients with over 30% of the hematocrit value as a therapeutic target increased from 7 to 32 among 41 patients. Twenty three of the 41 patients could decrease the dose of erythropoietin, and 5 patients could cease receiving the drug. Monthly total units of erythropoietin used for the 41 patients could also be decreased from 915000 units to 642000 units, resulting in considerable improvement of cost performance. Thus, active participation of pharmacists in management of renal anemia had great therapeutic and pharmacoecomic impact in Japan, as in North America.