VillageHealth Disease Management, 3 Hawthorn Parkway, Vernon Hills, IL, USA.
Ann Pharmacother. 2009 Nov;43(11):1857-66. doi: 10.1345/aph.1M035. Epub 2009 Oct 13.
To evaluate chronic kidney disease (CKD)-associated anemia management challenges and limitations and discuss strategies to improve treatment rates and patient response to therapy, monitoring of patient response to therapy, and education of prescribing providers and patients.
Multiple MEDLINE searches were performed using a comprehensive search term list to identify studies for inclusion, including, but not limited to, anemia, erythropoiesis-stimulating agent (ESA), epoetin, darbepoetin, CERA, hemoglobin, CKD, dialysis, end-stage renal disease, quality of life, and pharmacist. Annual data reports and clinical practice guidelines published by the National Kidney Foundation and US Renal Data System were included. Information provided within product package inserts for recombinant human erythropoietin (epoetin alfa; Epogen, Procrit) and darbepoetin alfa (Aranesp) were also included.
Only articles that were published in English and were relevant for this review were included.
Anemia is a common complication of CKD, with significant impact on patients' quality of life. Anemia of CKD represents a significant burden on the healthcare system, with ESA use resulting in substantial financial costs. As new therapies, formularies, and dosing regimens evolve, the collaborative role of the clinical pharmacist is integral to a multidisciplinary treatment strategy, both in the inpatient and outpatient settings, such as hospitals or dialysis centers, respectively. This review focuses on initial and target hemoglobin (Hb) concentrations, as well as patient characteristics, treatment preferences, and dosing schedules, which are important considerations in managing CKD-associated anemia. To ensure effective therapeutic strategies, a patient-centered approach is required. Pharmacists are ideally positioned to help select ESA therapy, influence formulary use, educate healthcare professionals and patients, develop and implement dosing and monitoring protocols, and possibly promote quality improvement.
An approach to CKD-associated anemia management that involves collaboration with pharmacists is essential to achieve patient-specific, cost-effective ESA therapy.
评估慢性肾脏病（CKD）相关贫血管理的挑战和局限性，并讨论改善治疗率和患者对治疗的反应、监测患者对治疗的反应以及教育处方提供者和患者的策略。
使用综合搜索词列表进行了多次 MEDLINE 搜索，以确定纳入的研究，包括但不限于贫血、红细胞生成刺激剂（ESA）、促红细胞生成素、达贝泊汀、CERA、血红蛋白、CKD、透析、终末期肾病、生活质量和药剂师。包括美国肾脏病基金会和美国肾脏数据系统发布的年度数据报告和临床实践指南。还包括重组人红细胞生成素（epoetin alfa；Epogen、Procrit）和达贝泊汀 alfa（Aranesp）的产品说明书中提供的信息。
仅纳入以英文发表且与本综述相关的文章。
贫血是 CKD 的常见并发症，对患者的生活质量有重大影响。CKD 贫血对医疗保健系统造成了重大负担，ESA 的使用导致了巨大的财务成本。随着新疗法、处方集和剂量方案的发展，临床药师的协作作用对于多学科治疗策略至关重要，无论是在住院还是门诊环境中，分别是医院或透析中心。本综述重点介绍初始和目标血红蛋白（Hb）浓度以及患者特征、治疗偏好和剂量方案，这些都是管理 CKD 相关贫血的重要考虑因素。为了确保有效的治疗策略，需要采取以患者为中心的方法。药剂师是帮助选择 ESA 治疗、影响处方使用、教育医疗保健专业人员和患者、制定和实施剂量和监测方案以及可能促进质量改进的理想人选。
与药剂师合作的 CKD 相关贫血管理方法对于实现针对患者的、具有成本效益的 ESA 治疗至关重要。
