Hamad Abdullah, Ezzat Hany, Latif Ghonimi Tarek Abdel, Ibrahim Rania, Ramadan Fatma, Noor Nadia, Yasin Fadumo, Ismail Sahar, Al-Ali Fadwa
Hamad Medical Corporation, Doha, Qatar E-mail:
Qatar Med J. 2021 Oct 21;2021(3):46. doi: 10.5339/qmj.2021.46. eCollection 2021.
Anemia management in dialysis is challenging. Keeping hemoglobin levels within a tight range is difficult. A new program (anemia nurse manager [ANM]) was started for better anemia management. This study aimed to compare traditional anemia management with the new ANM model regarding the achievement of better hemoglobin targets (range, 10-12 g/dL), avoidance of extreme hemoglobin levels ( < 9 or >13 g/dL), and evaluation of the cost-effectiveness of the new model.
This retrospective observational study compared traditional anemia management with management involving our new ANM model. Patients on hemodialysis in all ambulatory dialysis clinics in Qatar were included. The study included three phases: phase 1 (observation): June 2015 to August 2015, 460 patients; phase 2 (pilot): September 2015 to May 2016, 211 patients; and phase 3 (expansion in two phases): June 2016 to February 2017 and October 2017 to June 2018, 610 patients. Hemoglobin, iron saturation, and ferritin were evaluated according to the protocol.
In this study, 55% of the patients achieved the target hemoglobin in phase 1 compared with 75% in phase 2 ( = 0.0007). The hemoglobin level within the target range was sustained at 72% ± 5% of patients in phase 3. The achievement rate of the target hemoglobin level increased from 56% (May 2015) to 72% (July 2018) ( < 0.001). The proportion of patients with extreme hemoglobin declined from 10.7% in phase 1 to 6.4% in phase 2 and sustained at 8% afterward. Reducing the doses of erythropoietin stimulating agents, owing to the use of the ANM model, saved costs by approximately 11%.
The ANM model was able to achieve and maintain hemoglobin levels within the target range and decrease extreme hemoglobin levels. These outcomes improved patient care by avoiding high hemoglobin (increase thrombosis, cancer recurrence, stroke, and death) and low hemoglobin (weakness, poor quality of life, and need for transfusion) levels. The ANM model was cost effective even after including the salaries of nurses. This model can be considered in other aspects of patient care in dialysis.
透析患者的贫血管理颇具挑战。将血红蛋白水平维持在狭窄范围内并非易事。为了更好地管理贫血，启动了一项新计划（贫血护士管理[ANM]）。本研究旨在比较传统贫血管理与新的ANM模式在实现更好的血红蛋白目标（范围为10 - 12 g/dL）、避免血红蛋白水平极端值（< 9或> 13 g/dL）以及评估新模式的成本效益方面的差异。
这项回顾性观察研究将传统贫血管理与采用我们新的ANM模式的管理进行了比较。纳入了卡塔尔所有门诊透析诊所的血液透析患者。该研究包括三个阶段：第1阶段（观察期）：2015年6月至2015年8月，460例患者；第2阶段（试点期）：2015年9月至2016年5月，211例患者；以及第3阶段（分两阶段扩展）：2016年6月至2017年2月和2017年10月至2018年6月，610例患者。根据方案对血红蛋白、铁饱和度和铁蛋白进行评估。
在本研究中，第1阶段55%的患者达到了血红蛋白目标，而第2阶段为75%（P = 0.0007）。在第3阶段，72% ± 5%的患者血红蛋白水平维持在目标范围内。目标血红蛋白水平的达成率从2015年5月的56%提高到了2018年7月的72%（P < 0.001）。血红蛋白水平极端的患者比例从第1阶段的10.7%降至第2阶段的6.4%，之后维持在8%。由于采用了ANM模式，促红细胞生成素刺激剂的剂量减少，节省了约11%的成本。
ANM模式能够实现并维持血红蛋白水平在目标范围内，并降低血红蛋白水平极端值。这些结果通过避免高血红蛋白水平（增加血栓形成、癌症复发、中风和死亡）和低血红蛋白水平（虚弱、生活质量差以及需要输血）改善了患者护理。即使计入护士的薪水，ANM模式仍具有成本效益。在透析患者护理的其他方面也可考虑采用该模式。
