Satellite Healthcare, San Jose, CA, USA.
Curr Med Res Opin. 2011 Aug;27(8):1539-50. doi: 10.1185/03007995.2011.588202. Epub 2011 Jun 17.
To review issues and challenges in caring for hemodialysis patients with anemia of chronic kidney disease, specifically focusing on the effects of longer erythropoiesis-stimulating agent (ESA) dosing intervals on processes of care.
PubMed searches were performed limited to the last 10 years to February 2011, focusing on articles in English that were 'clinical trials,' assessed processes of care, measured associations of hemoglobin (Hb) with outcomes, and explored/analyzed extended dosing intervals of ESAs in hemodialysis patients and recommendations for increasing the quality of care of these patients. Some limitations included the fact that a meta-analysis was not conducted; many studies were associative and therefore unable to prove causality; and none of the clinical trials directly compared the impact of more frequent or less frequent ESA dosing strategies on patient care and outcomes.
Progress over the past several decades has been substantial; however, unmet needs remain and there is room for improvement in efficiencies of care. Many patients fail to meet Hb targets, and nephrology professionals' time is consumed with preparing, administering, and monitoring therapy. Direct interaction between patients and care providers has been lost as attention has shifted to 'cost-effective' (not necessarily patient-centered) ways to deliver care. Use of ESAs at longer dosage intervals represents one opportunity to improve efficiency of care. Newer ESAs have been developed for less frequent dosing. Once-monthly dosing decreases time spent administering/monitoring therapy and allows nephrology professionals to provide comprehensive renal care, wherein the patient rather than task-oriented processes becomes the primary focus.
A fragmented, uncoordinated care-delivery model heightens the urgency to systematically address issues related to delivery of care and improve efficiencies in anemia management as part of the patient-centered approach. ESAs designed for administration at longer intervals may effectively and reliably achieve Hb targets with once-monthly dosing, thereby decreasing time spent administering/monitoring therapy.
回顾慢性肾脏病贫血患者血液透析治疗中存在的问题和挑战，尤其关注延长红细胞生成刺激剂（ESA）给药间隔对治疗过程的影响。
对截至 2011 年 2 月过去 10 年的 PubMed 检索进行限制，仅检索英文“临床试验”文章，评估护理过程，测量血红蛋白（Hb）与结局的相关性，并探索/分析血液透析患者 ESA 延长给药间隔以及提高此类患者护理质量的建议。部分限制因素包括未进行荟萃分析；许多研究是相关性研究，因此无法证明因果关系；并且没有临床试验直接比较更频繁或更不频繁的 ESA 给药策略对患者护理和结局的影响。
过去几十年已取得重大进展；然而，仍存在未满足的需求，护理效率仍有改进空间。许多患者未能达到 Hb 目标，肾脏病专家的时间用于准备、给药和监测治疗。由于注意力转向提供“具有成本效益”（不一定以患者为中心）的护理方式，患者与护理提供者之间的直接互动已经丧失。更长的 ESA 剂量间隔的使用代表了提高护理效率的一个机会。开发了新的 ESA 药物用于更频繁的给药。每月一次的给药减少了给药/监测治疗的时间，使肾脏病专家能够提供全面的肾脏护理，患者而非以任务为导向的流程成为主要关注点。
分散、不协调的护理提供模式加剧了系统解决护理提供相关问题的紧迫性，并提高了贫血管理效率，作为以患者为中心方法的一部分。设计用于更长间隔给药的 ESA 可能通过每月一次的给药有效地可靠地达到 Hb 目标，从而减少给药/监测治疗的时间。
